Wolke J, Krüger D, Gerhardt C, Scheibel M
Centrum für Muskuloskeletale Chirurgie (CMSC), Charité-Universitätsmedizin Berlin, Campus-Virchow und Campus-Mitte, Augustenburger Platz 1, 13353, Berlin, Deutschland.
Unfallchirurg. 2014 Dec;117(12):1118-24. doi: 10.1007/s00113-013-2492-0.
Long-term results of conservative treatment of acute locked posterior shoulder dislocation with a reverse Hill-Sachs defect (Malgaigne lesion) <25% are rare. The aim of the present study was to evaluate the clinical and radiological results of patients after conservative treatment.
In this study 8 patients (8 male, average age 58.4 years) after non-operative treatment consisting of closed reduction and immobilization in 15° of external rotation were retrospectively clinically and radiologically examined (true anteroposterior, axillary and y view) The Constant score (CS), Rowe score (RS), Western Ontario shoulder instability index (WOSI) and the subjective shoulder value (SSV) were evaluated.
After a mean follow-up of 5.4 years (range 5-7 years) no patient reported a redislocation or resubluxation or a persistent feeling of instability. None of the patients stated that they had to avoid certain movements or were limited in their everyday life. The clinical tests for posterior instability (jerk test/Kim test) were negative in all patients. The mean CS was 87.4 (range 42-98) points, the RS 96.4 (range 55-100) points, the WOSI 89.1% (range 41-100%) and the SSV 89.1% (range 50-98%). The radiological evaluation of the affected shoulder in true anteroposterior, axillary and y views showed signs of osteoarthritis (grade II according to Samilson and Prieto) in two cases. The humeral head was centered in all eight cases.
Non-operative treatment of acute locked posterior shoulder dislocation demonstrated good to excellent clinical and radiological long-term results in this study. It represents the treatment of choice in patients with a reverse Hill-Sachs defect (Malgaigne lesion) < 25% and a duration of dislocation < 3 weeks.
对于急性锁定性后肩关节脱位伴反向Hill-Sachs缺损（马尔盖尼损伤）小于25%的患者，保守治疗的长期结果鲜有报道。本研究旨在评估保守治疗患者的临床和影像学结果。
本研究对8例（均为男性，平均年龄58.4岁）采用闭合复位并外旋15°固定进行非手术治疗的患者进行了回顾性临床和影像学检查（包括真正前后位、腋位和Y位）。评估了Constant评分（CS）、Rowe评分（RS）、西安大略肩关节不稳定指数（WOSI）和主观肩关节评分（SSV）。
平均随访5.4年（范围5 - 7年），无患者报告再脱位、半脱位或持续的不稳定感。所有患者均表示无需避免特定动作或日常生活受限。所有患者的后向不稳定临床检查（急拉试验/金氏试验）均为阴性。CS平均为87.4分（范围42 - 98分），RS为96.4分（范围55 - 100分），WOSI为89.1%（范围41 - 100%），SSV为89.1%（范围50 - 98%）。在真正前后位、腋位和Y位对患肩进行的影像学评估显示，2例出现骨关节炎迹象（根据Samilson和Prieto分级为II级）。8例患者的肱骨头均居中。
本研究表明，急性锁定性后肩关节脱位的非手术治疗在临床和影像学方面均取得了良好至优异的长期效果。对于反向Hill-Sachs缺损（马尔盖尼损伤）小于25%且脱位持续时间小于3周的患者，这是首选的治疗方法。
