Flatow E L, Miller S R, Neer C S
From the Shoulder Service, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York.
J Shoulder Elbow Surg. 1993 Jan;2(1):2-10. doi: 10.1016/S1058-2746(09)80131-6. Epub 2009 Feb 19.
The treatment of 17 chronic, unreduced anterior dislocations of the shoulder was reviewed. Eleven women and six men with on average age of 67 years (range 36 to 88 years) were studied. The duration of dislocation averaged 2.3 years (8 weeks to 8 years). Seven patients were treated without surgery despite severe functional deficits, for reasons of health or motivation. Ten were treated with surgery. One patient with preserved joint surfaces underwent open reduction and corticoid transfer to bone graft an eroded anterior glenoid. Nine patients with destroyed articular surfaces underwent unconstrained replacement orthroplosty. Humeral retroversion was increased for stability. The soft tissues were reattached, and rehabilitation was modified as with a repair of recurrent dislocations. Anterior glenoid erosion was often present and required bone grafting to support the glenoid component in four shoulders. Two chronic rotator cuff tears required repair. Nine patients were followed from 2 to 6 years, with an average of 3.9 years. The results were four excellent, four satisfactory, and one unsatisfactory. Although the reconstruction is complex, the surgical results were clearly superior to those of the nonoperative group.
对17例慢性、未复位的肩关节前脱位的治疗情况进行了回顾。研究对象包括11名女性和6名男性，平均年龄67岁（范围36至88岁）。脱位持续时间平均为2.3年（8周至8年）。7例患者因健康或动机原因，尽管存在严重功能缺陷但未接受手术治疗。10例接受了手术治疗。1例关节面完好的患者接受了切开复位及皮质骨转移至侵蚀的前方关节盂进行植骨。9例关节面破坏的患者接受了非限制性置换成形术。为了稳定，增加了肱骨后倾。重新附着软组织，并像修复复发性脱位一样调整康复方案。前方关节盂侵蚀经常出现，4例肩关节需要植骨以支撑关节盂部件。2例慢性肩袖撕裂需要修复。9例患者随访2至6年，平均3.9年。结果为4例优，4例良，1例差。尽管重建过程复杂，但手术结果明显优于非手术组。
