Noh Young Min, Do Hyun Su, Heo Si Young
Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan, Korea.
Radiol Case Rep. 2020 Jul 16;15(9):1657-1662. doi: 10.1016/j.radcr.2020.07.004. eCollection 2020 Sep.
We report a case of a 78-year old female patient got the reverse total shoulder arthroplasty with a series of events. After diagnosed with anterior shoulder dislocation and coracoid process fracture at a local hospital, she received conservative care after reduction but persistent reduction loss occurred. Preoperative Magnetic Resonance Imaging confirmed underlying massive fatty infiltration and severe retraction of rotator cuff muscles. Considering underlying chronic rotator cuff arthropathy on preoperative X-ray and Computed Tomography scan with irreparable rotator cuff tears, we decided to perform reverse total shoulder arthroplasty. After unexpected vessel injury possibly due to underlying bleeding tendency or intra-operative procedure, severe complications occurred including active arterial bleeding, brachial plexus palsy and skin necrosis. Serial managements which included embolization of the artery, wound management while implant exposure status, and operative coverage of a skin defect by Latissimus Dorsi pedicled flap and Split Thickness Skin Graft were done. This series of events suggests that surgeons should be more careful than we were about possible injuries of small vessel branches that can cause unexpected complications, and keep in mind the importance of immediate cooperation with other medical professionals such as radiologists, plastic surgeons, and thoracic surgeons.
我们报告了一例78岁女性患者接受反式全肩关节置换术时发生的一系列事件。在当地医院被诊断为肩关节前脱位和喙突骨折后，她复位后接受了保守治疗，但持续出现复位丢失。术前磁共振成像证实存在大量脂肪浸润和肩袖肌肉严重回缩。考虑到术前X线和计算机断层扫描显示存在潜在的慢性肩袖关节病且肩袖撕裂无法修复，我们决定进行反式全肩关节置换术。在可能由于潜在出血倾向或术中操作导致意外血管损伤后，出现了严重并发症，包括活动性动脉出血、臂丛神经麻痹和皮肤坏死。我们进行了一系列处理，包括动脉栓塞、在植入物暴露状态下进行伤口处理，以及采用背阔肌带蒂皮瓣和中厚皮片移植对皮肤缺损进行手术覆盖。这一系列事件表明，外科医生应比我们更加小心可能导致意外并发症的小血管分支损伤，并牢记与放射科医生、整形外科医生和胸外科医生等其他医学专业人员立即合作的重要性。
