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一名儿科患者肩关节直举脱位的磁共振关节造影表现——关节镜证实及文献复习

MR arthrogram findings of luxatio erecta in a pediatric patient-arthroscopic confirmation and review of the literature.

作者信息

Stensby J Derek, Fox Michael G

机构信息

Department of Radiology and Medical Imaging, University of Virginia, 1218 Lee Street, Box 800170, Charlottesville, VA, 22908, USA.

出版信息

Skeletal Radiol. 2014 Aug;43(8):1191-4. doi: 10.1007/s00256-014-1874-x. Epub 2014 Apr 3.

Abstract

Luxatio erecta or inferior glenohumeral dislocation is a rare type of shoulder dislocation, accounting for less than 1 % of all reported shoulder dislocations. We describe a 15-year-old male who presented with luxatio erecta following an injury to his shoulder that resulted from a mountain biking accident. Clinically, the patient had shoulder pain and fixed abduction of the arm. Radiographs confirmed the diagnosis of luxatio erecta. A magnetic resonance arthrogram (MRA) performed 9 days after presentation demonstrated both a greater tuberosity fracture and avulsion of the anterior and posterior inferior glenohumeral ligaments from their humeral attachment. The MR findings were confirmed on arthroscopy. The bone and soft tissue injury pattern seen in our patient clearly supports the described mechanism of injury for luxatio erecta and lends credence to the theory that a fracture of the greater tuberosity spares injury to the rotator cuff, especially in children. A review of the literature failed to reveal any prior description of the MRI or MRA findings of luxatio erecta in a pediatric patient or any publication with arthroscopic confirmation of the MR findings.

摘要

肩关节下脱位或肩肱关节下脱位是一种罕见的肩关节脱位类型,占所有报告的肩关节脱位的比例不到1%。我们描述了一名15岁男性,他在一次山地自行车事故导致肩部受伤后出现了肩关节下脱位。临床上,患者肩部疼痛,手臂固定在外展位。X线片证实了肩关节下脱位的诊断。在就诊9天后进行的磁共振关节造影(MRA)显示了大结节骨折以及肩肱关节下前后韧带从肱骨附着处的撕脱。关节镜检查证实了磁共振成像的结果。我们患者中所见的骨和软组织损伤模式明确支持了所描述的肩关节下脱位的损伤机制,并支持了大结节骨折可使肩袖免受损伤这一理论,尤其是在儿童中。对文献的回顾未发现之前有关于儿科患者肩关节下脱位的MRI或MRA表现的任何描述,也未发现任何经关节镜证实磁共振成像结果的出版物。

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