Orthopaedic and Traumatology Department, University of Modena and Reggio Emilia Policlinico Di ModenaVia del Pozzo 71, 41124, Modena, Italy.
Orthopaedic and Traumatology Unit, Ospedale Civile di Faenza, Faenza, Italy.
Musculoskelet Surg. 2022 Sep;106(3):239-245. doi: 10.1007/s12306-021-00702-1. Epub 2021 Mar 8.
Chronic anterior shoulder dislocation represents a rare condition, and there is still lack of consensus in its treatment. Purpose of this study is to evaluate the clinical and radiological outcome of painful locked dislocation underwent shoulder replacement, with a minimum follow-up of two years. Second endpoint is to assess the glenoid bone graft, harvested from the humeral head.
Eight patients underwent shoulder replacement for locked anterior shoulder dislocation. Four patients with a mean age of 23 y.o. were treated with Pyrocarbon-hemiarthroplasty and four patients with a mean age of 76 y.o. were treated with reverse shoulder arthroplasty. Glenoid single stage reconstruction was performed with a bone autograft harvested from the resected humeral head. Patients were observed for a clinical and radiological follow-up for a minimum period of 2 years; ASES and Constant score were assessed.
Pain and ROM improvement was reported in all the patients. In one case, postoperative recurrent RSA instability was found. Glenoid reconstruction was performed in seven cases, showing a good integration and no reabsorption issues in all but one cases. ASES and Constant-Murley functional outcomes were rated as excellent by 1 patient with pyrocarbon HA and 1 patient with RSA, good by 3 patients with RSA and 2 patients with HA, fair by 1 patient with HA and poor by one patient with RSA.
The treatment of locked anterior glenohumeral dislocation still represents a challenge in symptomatic patients. Shoulder replacement showed good results in young and older patients, with HA and RSA, respectively. Autograft from the humeral head is reliable for glenoid defect, even in ream and run procedure. Locked dislocation lasting more than one year, surgery is debatable for higher risk of a poor outcome and recurrent instability.
慢性复发性肩关节前脱位较为罕见，其治疗方法仍存在争议。本研究旨在评估因疼痛导致的复发性肩关节前脱位行肩关节置换术的临床和影像学结果，所有患者的随访时间均至少为 2 年。次要终点为评估取自肱骨头的关节盂骨移植物。
8 例因复发性肩关节前脱位而接受肩关节置换术的患者纳入研究。4 例 23 岁的患者接受了半肩关节置换术，4 例 76 岁的患者接受了反肩关节置换术。采用取自切除肱骨头的自体骨进行关节盂的一期重建。所有患者均接受了至少 2 年的临床和影像学随访，评估 ASES 和 Constant 评分。
所有患者的疼痛和活动度均得到改善。1 例患者术后出现复发性 RSA 不稳定。7 例患者进行了关节盂重建，除 1 例外，所有患者的重建关节盂均获得了良好的融合，无吸收现象。1 例接受半肩关节置换术和 1 例接受反肩关节置换术的患者的 ASES 和 Constant-Murley 功能评分结果为优，3 例接受反肩关节置换术和 2 例接受半肩关节置换术的患者的评分结果为良，1 例接受半肩关节置换术的患者的评分为可，1 例接受反肩关节置换术的患者的评分为差。
对于有症状的复发性肩关节前脱位患者，治疗仍然是一个挑战。在年轻和老年患者中，半肩关节置换术和反肩关节置换术的疗效均较好。取自肱骨头的自体骨是关节盂骨缺损可靠的移植物，即使在扩孔和打压植骨术中也是如此。对于持续 1 年以上的复发性肩关节前脱位，手术的选择存在争议，因为手术的风险较高，且容易出现预后不良和复发性不稳定。
