Department of Orthopaedics, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
Department of Orthopaedics, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
J Shoulder Elbow Surg. 2014 Nov;23(11):1682-90. doi: 10.1016/j.jse.2014.03.017. Epub 2014 Jun 12.
Locked posterior glenohumeral dislocations with impaction fractures involving less than 30% to 35% of the humeral head are most frequently treated with lesser tuberosity transfer into the defect, whereas those involving more than 35% to 40% are treated with humeral head arthroplasty. As an alternative, reconstruction of the defect with segmental femoral or humeral head allograft has been proposed, but the long-term outcome of this joint-preserving procedure is unknown.
Twenty-two shoulders in 21 patients with a locked posterior shoulder dislocation and an impaction of at least 30% (mean, 43%) of the humeral head were treated with segmental reconstruction of the humeral head defect. They were reviewed clinically and radiographically at a minimum follow-up of 5 years.
Of the 22 shoulders, 19 could be followed up at 128 months (range, 60-294 months) postoperatively. Only 2 of the 19 patients needed a prosthesis more than 180 months after the index operation. Of the other 17, 4 had radiographically advanced osteoarthritis (OA), 4 had mild OA, and 9 had no or minimal OA. Eighteen shoulders were rated as subjectively excellent, none were rated as good, and one was rated as fair. The final Constant-Murley score averaged 77 points (range, 52-98 points), the Subjective Shoulder Value averaged 88% (range, 75%-100%), and only 2 patients had mild to moderate pain. Mean active anterior elevation was 145°, and mean external rotation with the arm at the side was 42°.
Segmental reconstruction of humeral head defects for large anteromedial impaction fractures caused by locked posterior dislocations durably restores stability and freedom from pain with an excellent subjective long-term outcome.
对于累及小于 30%-35%肱骨头的后盂唇锁扣伴盂肱关节前上部压缩骨折，通常采用较小的结节转位入缺损处治疗；而累及超过 35%-40%肱骨头的骨折则采用肱骨头置换治疗。作为替代方法，已提出用节段性股骨干或肱骨头同种异体骨重建缺损，但这种保关节手术的长期结果尚不清楚。
21 例患者中有 22 例（22 肩）伴至少 30%（平均 43%）肱骨头的后盂唇锁扣伴盂肱关节前上部压缩骨折患者采用节段性肱骨头缺损重建治疗。所有患者均接受了至少 5 年的临床和影像学随访。
22 例患者中，19 例可获得术后 128 个月（60-294 个月）的随访。仅 2 例患者在指数手术后 180 个月以上需要更换假体。另外 17 例中，4 例有影像学进展性骨关节炎（OA），4 例有轻度 OA，9 例无或轻度 OA。18 例患者的主观评估结果为优，无一例为良，1 例为可。最终的 Constant-Murley 评分为 77 分（52-98 分），主观肩部值为 88%（75%-100%），仅有 2 例患者有轻度到中度疼痛。主动前屈平均为 145°，手臂在体侧外旋平均为 42°。
对于由后盂唇锁扣引起的大的前内侧压缩骨折导致的肱骨头节段性缺损重建，可持久恢复稳定性和无痛性，并获得极好的主观长期结果。
