Rapariz Jose M, Martin-Martin Silvia, Pareja-Bezares Antonio, Ortega-Klein Jose
Department of Orthopedic Surgery, Hospital Son Llàtzer, Palma de Mallorca, Spain.
Int J Shoulder Surg. 2010 Oct;4(4):88-92. doi: 10.4103/0973-6042.79792.
Recurrent anterior shoulder dislocation in elderly patients is a little studied condition. The goal of this paper is to clarify the role of associated injuries with respect to loss of function and recurrence of dislocation.
We have conducted a retrospective, descriptive study on 29 patients older than 60 years at the moment they suffered their first dislocation episode. All patients were assessed clinically (Constant test) and by imaging testing (X-ray, MRI).
Nine (31.03%) out of 29 patients had a recurrent dislocation. Four of them required reconstructive surgery to maintain joint stability. Injury to the anterior support (anterior labrum, anterior glenoid rim) showed a statistically significant relation to the recurrence of dislocations. The occurrence or non-occurrence of a rotator cuff tear does have an impact on the shoulder function. The degree of rotator cuff involvement on the coronal plane does not significantly affect the shoulder's functional outcome. The tear extension on the sagittal plane does cause impairment on the Constant test.
Labrum and/or anterior glenoid involvement should be suspected in elderly patients presenting with recurrent shoulder dislocation. Recurrence is due to an injury in the anterior support or both (anterior and posterior), even though shoulder function gets impaired when a rotation cuff tear occurs with anterior extension on the sagittal plane. Evidence level: IV Case series.
老年患者复发性肩关节前脱位是一种研究较少的病症。本文的目的是阐明相关损伤在功能丧失和脱位复发方面的作用。
我们对29例60岁以上首次发生脱位的患者进行了一项回顾性描述性研究。所有患者均接受了临床评估（Constant试验）和影像学检查（X线、MRI）。
29例患者中有9例（31.03%）出现复发性脱位。其中4例需要进行重建手术以维持关节稳定性。前支撑结构损伤（前盂唇、前肩胛盂边缘）与脱位复发之间存在统计学上的显著关联。肩袖撕裂的发生与否确实会对肩部功能产生影响。肩袖在冠状面上的受累程度对肩部功能结果没有显著影响。矢状面上的撕裂范围确实会导致Constant试验结果受损。
对于出现复发性肩关节脱位的老年患者，应怀疑存在盂唇和/或前肩胛盂受累。复发是由于前支撑结构或两者（前侧和后侧）损伤所致，尽管当矢状面上有前向延伸的肩袖撕裂发生时肩部功能会受损。证据水平：IV级病例系列。
