Blasier R B, Burkus J K
Division of Orthopedics, University of Michigan, Ann Arbor 48109.
Clin Orthop Relat Res. 1988 Jul(232):197-204.
Posterior fracture-dislocation of the shoulder is rare. Comprehensive treatment guidelines for posterior fracture-dislocation of the shoulder with fracture of the humeral head have not been previously published. Although open reduction and internal fixation of the proximal humerus for posterior fracture-dislocation has been reported in several series, the successful reconstruction of the articular surface by rigid internal fixation of a large osteochondral fragment has not been reported. This paper describes two cases of posterior fracture-dislocation of the shoulder with a substantial defect of the anteromedial humeral head resulting from the cleavage of a large osteochondral fragment. Preoperative computed axial tomographic (CAT) scanning of the injured shoulders helped in operative planning by precisely defining the extent of the articular injury. Accurate reconstruction of the articular surface restored joint stability and gave excellent clinical results. Large humeral head osteochondral fracture fragments require accurate reduction and internal fixation.
肩关节后脱位骨折较为罕见。此前尚未发表过关于伴有肱骨头骨折的肩关节后脱位骨折的综合治疗指南。尽管已有多个系列报道了对近端肱骨后脱位骨折进行切开复位内固定，但通过对大的骨软骨碎片进行坚强内固定成功重建关节面的情况尚未见报道。本文描述了两例因大的骨软骨碎片劈裂导致肱骨头前内侧出现实质性缺损的肩关节后脱位骨折病例。术前对受伤肩部进行计算机轴向断层扫描（CAT）有助于精确确定关节损伤的范围，从而进行手术规划。关节面的精确重建恢复了关节稳定性，并取得了优异的临床效果。大的肱骨头骨软骨骨折碎片需要精确复位和内固定。
