Department of Orthopaedic Surgery, School of Medicine, Ewha Womans University, Seoul, Korea.
Am J Sports Med. 2012 Apr;40(4):822-7. doi: 10.1177/0363546511434522. Epub 2012 Jan 27.
The prevalence of traumatic anterior shoulder dislocation in the elderly population has increased; however, no consensus has been reached regarding the management of shoulder dislocations in elderly patients.
This study investigated the clinical manifestations of traumatic anterior shoulder dislocation in patients older than 60 years and evaluated the functional outcomes of different treatment modalities based on associated abnormalities and the number of dislocations.
Case series; Level of evidence, 4.
Sixty-seven patients older than 60 at the time of primary shoulder dislocation were included. Magnetic resonance imaging or ultrasonography was performed on all patients to confirm associated injuries. Fifty-two patients were treated for primary shoulder dislocation and 15 for recurrent dislocation.
Postinjury examinations revealed no associated injuries in 31 patients with primary shoulder dislocation; these patients recovered shoulder function after rehabilitation (American Shoulder and Elbow Surgeons [ASES] score: 93 ± 6; Constant score: 89 ± 8). For the other 36 patients, 33 were found to have rotator cuff tears (isolated cuff tears in 16), and 3 were found to have an isolated Bankart lesion. The average ASES score of the 17 patients with primary shoulder dislocation who were treated operatively was 83 ± 10, and the average Constant score was 78 ± 13 at final follow-up. The average ASES score of patients with recurrent shoulder dislocation was 89 ± 9, and the average Constant score was 84 ± 13. No statistically significant differences in functional shoulder outcomes between patients with primary and recurrent dislocation were evident (P > .05). However, patients who were treated nonoperatively showed significantly better recovery of shoulder function than patients who were treated operatively regardless of the number of dislocations (P < .001). No recurrent shoulder dislocation was observed in any patient during an average follow-up period of 55 months.
The accurate diagnosis of associated injuries after traumatic anterior shoulder dislocation in patients older than 60 is critical for the recovery of shoulder function because more than half of patients had rotator cuff tears or anterior capsulolabral lesions, which may lead to recurrent shoulder dislocation. Satisfactory clinical outcomes without recurrence were obtained after early detection of abnormalities and different treatment modalities based on associated injuries and the number of dislocations experienced.
老年人创伤性前肩脱位的患病率有所增加；然而，对于老年患者肩脱位的处理方法尚未达成共识。
本研究调查了 60 岁以上创伤性前肩脱位患者的临床表现，并根据相关异常和脱位次数评估了不同治疗方式的功能结果。
病例系列；证据水平，4 级。
共纳入 67 例初次肩脱位时年龄大于 60 岁的患者。所有患者均行磁共振成像或超声检查以确认相关损伤。52 例患者接受了原发性肩脱位治疗，15 例患者接受了复发性脱位治疗。
初次肩脱位后检查发现 31 例患者无相关损伤，这些患者经康复治疗后恢复了肩部功能（美国肩肘外科医师协会[ASES]评分：93±6；Constant 评分：89±8）。对于其余 36 例患者，33 例患者发现肩袖撕裂（16 例为孤立性肩袖撕裂），3 例患者发现孤立性 Bankart 病变。17 例接受手术治疗的原发性肩脱位患者的平均 ASES 评分为 83±10，末次随访时平均 Constant 评分为 78±13。复发性肩脱位患者的平均 ASES 评分为 89±9，平均 Constant 评分为 84±13。原发性和复发性脱位患者的肩部功能恢复结果无统计学差异（P＞.05）。然而，无论脱位次数多少，非手术治疗的患者肩部功能恢复明显优于手术治疗的患者（P＜.001）。在平均 55 个月的随访期间，无患者出现复发性肩脱位。
对于 60 岁以上创伤性前肩脱位患者，准确诊断相关损伤对于肩部功能的恢复至关重要，因为超过一半的患者有肩袖撕裂或前关节囊盂唇病变，这可能导致复发性肩脱位。早期发现异常并根据相关损伤和脱位次数采用不同的治疗方法可获得满意的临床结果且无复发。
