Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing, China.
Department of Orthopaedics, Beijing Mentougou District Hospital, Beijing, China.
Orthop Surg. 2021 Oct;13(7):2119-2126. doi: 10.1111/os.13152. Epub 2021 Oct 11.
To evaluate the outcomes of locked posterior shoulder dislocation with reverse Hill-Sachs lesions in patients treated with anatomical reconstructions.
Patients who were treated at our institution between January 2016 and June 2020 were retrospectively reviewed. The demographics of the patients including gender, age, occupation, and dominant arm were recorded. Eleven cases from 10 patients qualified in this study. Nine males and one female were included. The mean age of the patients was 44.8 years (range, 33-54 years). Mechanism of injury, duration between injuries and definitive diagnosis, misdiagnosis, size of humeral head impaction, treatment maneuver, and details of operation performed were reviewed. Plain radiographs and computed tomography (CT) scan were taken to determine the size of defects preoperatively and fracture healing during follow-up. During surgery, the deltopectoral approach was employed. Anatomical reconstruction procedure including reduction, disimpaction, bone grafting, and fixation were sequentially performed. Either cancellous autograft from iliac crest or allograft were used and the fractures were anatomically reduced and stabilized by screws or plates. Visual Analog Scale (VAS) and Constant-Murley score were recorded to determine the functional outcomes preoperatively, at 3 months and 6 months postoperatively, and at the last follow-up. The range of motion in forward flexion was recorded at 6 months follow-up postoperatively.
Causes of injuries included epileptic seizure in four cases, fall in three cases, and road traffic accident in three cases. Misdiagnoses occurred in five out of 10 patients. The mean time between injury and definitive treatment among those misdiagnosed was 112 days. The mean size of the impacted reverse Hill-Sachs lesions was 33.95% (range, 19.1%-42.6%). All patients received surgical management with anatomical reconstruction approach, including open reduction, disimpaction, bone grafting, and internal fixation. The mean amount of bleeding during operation was 450 mL. The mean follow-up period was 22.6 months. Fracture healing was observed by 8 weeks in all cases postoperatively and evidence of bone grafting could not be further detected on CT scan at 6 month during follow-up. VAS was significantly lower at the last follow-up (0.68 ± 0.21) in comparison to preoperative scores (4.96 ± 0.97) (P < 0.05). Constant-Murley was improved significantly at the last follow-up (91.7 ± 8.3) in comparison to that preoperatively (40.6 ± 10.3) (P < 0.05). The mean range of motion in forward flexion was 38.25° ± 9.36° preoperatively and significantly improved to 162.48° ± 12.68° at 6-month follow-up (P < 0.05).
The anatomical reconstruction procedure by open reduction and bone augmentation for the treatment of locked posterior shoulder dislocation with reverse Hill-Sachs lesion was promising in both fracture healing and functional outcomes.
评估接受解剖重建治疗的伴有反向 Hill-Sachs 损伤的锁定性后肩脱位患者的治疗效果。
回顾性分析了 2016 年 1 月至 2020 年 6 月期间在我院接受治疗的患者。记录患者的人口统计学资料，包括性别、年龄、职业和优势臂。共有 10 例患者中的 11 例符合本研究标准。9 例男性，1 例女性。患者平均年龄为 44.8 岁（范围 33-54 岁）。记录损伤机制、损伤与明确诊断之间的时间间隔、误诊、肱骨头撞击的大小、治疗手法以及手术细节。术前拍摄 X 线和 CT 扫描以确定缺损的大小，并在随访期间观察骨折愈合情况。术中采用三角肌胸大肌入路。依次进行解剖复位、脱位复位、植骨和固定等解剖重建手术。使用取自髂嵴的松质骨自体移植物或同种异体移植物，骨折通过螺钉或钢板进行解剖复位和稳定。术前、术后 3 个月和 6 个月以及末次随访时记录视觉模拟评分（VAS）和 Constant-Murley 评分，以评估功能结果。术后 6 个月随访时记录前屈活动度。
损伤原因包括 4 例癫痫发作、3 例跌倒和 3 例道路交通伤。10 例患者中有 5 例发生误诊。误诊患者的平均确诊时间为 112 天。平均反向 Hill-Sachs 损伤的撞击大小为 33.95%（范围 19.1%-42.6%）。所有患者均接受解剖重建手术治疗，包括切开复位、脱位复位、植骨和内固定。术中平均出血量为 450ml。平均随访时间为 22.6 个月。所有患者术后 8 周均可见骨折愈合，随访期间 CT 扫描未见植骨进一步吸收。末次随访时 VAS（0.68±0.21）明显低于术前（4.96±0.97）（P<0.05）。末次随访时 Constant-Murley 评分（91.7±8.3）明显高于术前（40.6±10.3）（P<0.05）。术前前屈活动度平均为 38.25°±9.36°，术后 6 个月随访时显著改善至 162.48°±12.68°（P<0.05）。
切开复位和骨增量解剖重建治疗伴有反向 Hill-Sachs 损伤的锁定性后肩脱位，在骨折愈合和功能结果方面均有较好的效果。
