Tallaght University Hospital, Dublin, Republic of Ireland.
Royal College of Surgeons in Ireland, Dublin, Republic of Ireland.
Bone Joint J. 2019 Jan;101-B(1):15-21. doi: 10.1302/0301-620X.101B1.BJJ-2018-0984.R1.
The glenohumeral joint is the most frequently dislocated articulation, but possibly due to the lower prevalence of posterior shoulder dislocations, approximately 50% to 79% of posterior glenohumeral dislocations are missed at initial presentation. The aim of this study was to systematically evaluate the most recent evidence involving the aetiology of posterior glenohumeral dislocations, as well as the diagnosis and treatment.
A systematic search was conducted using PubMed (MEDLINE), Web of Science, Embase, and Cochrane (January 1997 to September 2017), with references from articles also evaluated. Studies reporting patients who experienced an acute posterior glenohumeral joint subluxation and/or dislocation, as well as the aetiology of posterior glenohumeral dislocations, were included.
A total of 54 studies met the inclusion criteria. In total, 182 patients were included in this analysis; study sizes ranged from one to 66 patients, with a mean age of 44.2 years (sd 13.7). There was a higher proportion of male patients. In all, 216 shoulders were included with 148 unilateral injuries and 34 bilateral. Seizures were implicated in 38% of patients (n = 69), with falls, road traffic accidents, electric shock, and iatrogenic reasons also described. Time to diagnosis varied across studies from immediate up to a delay of 25 years. Multiple associated injuries are described.
This review provides an up-to-date insight into the aetiology of posterior shoulder dislocations. Our results showed that seizures were most commonly implicated. Overall, reduction was achieved via open means in the majority of shoulders. We also found that delayed diagnosis is common.
盂肱关节是最常发生脱位的关节，但由于后肩脱位的发病率较低，约有 50%至 79%的初次就诊时漏诊了后盂肱关节脱位。本研究旨在系统评估涉及后盂肱关节脱位病因、诊断和治疗的最新证据。
使用 PubMed（MEDLINE）、Web of Science、Embase 和 Cochrane（1997 年 1 月至 2017 年 9 月）进行系统检索，并对文章中的参考文献进行评估。纳入报告急性后盂肱关节半脱位和/或脱位以及后盂肱关节脱位病因的患者的研究。
共有 54 项研究符合纳入标准。共有 182 名患者纳入本分析；研究规模从 1 例到 66 例，平均年龄为 44.2 岁（标准差 13.7）。男性患者比例较高。共纳入 216 个肩关节，其中 148 个为单侧损伤，34 个为双侧损伤。38%的患者（n=69）有癫痫发作史，还有跌倒、道路交通事故、电击和医源性等原因。从即刻到 25 年的延迟，各研究的诊断时间各不相同。还描述了多种相关损伤。
本综述提供了对后肩脱位病因的最新见解。我们的结果表明，癫痫发作最常被牵涉其中。总体而言，大多数肩关节通过开放方式复位。我们还发现诊断延迟很常见。
