Kokkalis Zinon T, Mavrogenis Andreas F, Ballas Efstathios G, Papagelopoulos Panayiotis J, Zoubos Aristides B
First Department of Orthopaedics, Athens University Medical School, Attikon University Hospital, Athens, Greece.
Orthopedics. 2012 Oct;35(10):e1537-41. doi: 10.3928/01477447-20120919-26.
Posterior dislocation of the shoulder is an uncommon injury. Diagnosis is difficult and often missed. Once diagnosed, management must be individualized depending on the amount of the defect of the humeral head and the time from injury. This article presents a case of a 40-year-old man with a 4-month history of bilateral locked posterior fracture-dislocation of the shoulders after a grand mal seizure. Imaging showed loss of the glenohumeral joint lines congruency, reverse Hill-Sachs lesions, and articular defects of 35% and 40% of the humeral heads. A modified McLaughlin technique was performed in both shoulders in a single stage. Through the standard deltopectoral approach, the lesser tuberosity was osteotomized with the subscapularis and capsule attached and elevated to expose the humeral head and glenoid. The shape of the humeral head was restored by packing the defect with morselized bone allograft. Before packing the allograft into the defect, 2 absorbable suture anchors were inserted at the bottom of the defect; the lesser tuberosity was transferred into the defect, and fixed with 2 transosseous horizontal mattress sutures. Stable fixation was evaluated intraoperatively, and the wound was closed in layers. Postoperatively, both shoulders were immobilized with external rotation braces for 6 weeks, followed by passive, active-assisted, and progressively active range of shoulder motion and rotator cuff strengthening exercises for the next 6 weeks. At 12 weeks postoperatively, full range of motion was accomplished, and full activity was allowed. At 22-month follow-up, the patient was satisfied with his level of function; both shoulder joints were painless and stable without apprehension or recurrence of instability. Radiographs showed congruent joints and complete incorporation of the allograft into the defect with restoration of the shape of the humeral head.
肩关节后脱位是一种少见的损伤。诊断困难，常被漏诊。一旦确诊，治疗必须个体化，取决于肱骨头缺损的程度和受伤时间。本文介绍了一例40岁男性患者，在一次癫痫大发作后双侧肩关节锁定性后骨折脱位4个月。影像学检查显示盂肱关节线一致性丧失、反Hill-Sachs损伤以及肱骨头35%和40%的关节面缺损。在双侧肩部一期采用改良的麦克劳林技术。通过标准的三角肌胸大肌入路，将小结节与肩胛下肌和关节囊一并截骨并抬起，以暴露肱骨头和关节盂。用碎骨同种异体骨填充缺损来恢复肱骨头的形状。在将同种异体骨填充到缺损之前，在缺损底部插入2个可吸收缝线锚钉；将小结节转移到缺损处，并用2根经骨水平褥式缝线固定。术中评估固定稳定性，然后分层缝合伤口。术后，双侧肩部用外旋支具固定6周，接下来的6周进行被动、主动辅助和逐渐增加活动度的肩部运动以及肩袖强化锻炼。术后12周，达到了全范围活动，并允许进行完全活动。在22个月的随访中，患者对其功能水平满意；双侧肩关节无痛且稳定，无恐惧或不稳定复发。X线片显示关节一致，同种异体骨完全融入缺损，肱骨头形状恢复。
