Hawi N, Ratuszny D, Liodakis E, Omar M, Krettek C, Meller R
Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
Unfallchirurg. 2018 Feb;121(2):126-133. doi: 10.1007/s00113-017-0421-3.
In contrast to shoulder dislocations in younger patients, anterior shoulder dislocation in the elderly is often associated with concomitant injuries to the rotator cuff and fractures. There is also frequent involvement of the brachial plexus or peripheral nerves. After closed reduction and a short period of immobilization, physiotherapy should be performed to restore mobility and strength. The evaluation of the rotator cuff is essential for further treatment decisions. The majority of patients are classically treated conservatively. Elderly patients with accompanying rotator cuff lesions and failed conservative therapy can benefit from a surgical intervention. Reconstructive interventions of the rotator cuff should be principally considered; however, some individuals may benefit from a reverse prosthesis in this elderly subgroup of patients. The challenge for the treating surgeon is to exactly define the structural injury of the shoulder (which may include pre-existing lesions) and to select the optimal treatment option.
与年轻患者的肩关节脱位不同，老年人的前肩关节脱位常伴有肩袖损伤和骨折。臂丛神经或周围神经也常受累。在闭合复位和短期固定后，应进行物理治疗以恢复活动度和力量。肩袖评估对于进一步的治疗决策至关重要。大多数患者通常采用保守治疗。伴有肩袖损伤且保守治疗失败的老年患者可从手术干预中获益。应主要考虑肩袖的重建干预；然而，在这个老年患者亚组中，一些人可能从反置假体中获益。治疗外科医生面临的挑战是准确界定肩部的结构损伤（可能包括既往病变）并选择最佳治疗方案。
