Cárdenas Gabriel, Gasbarro Gregory, Aceituno Gianella
Department of Orthopaedics, Instituto de Seguridad del Trabajo, Viña del Mar, Chile.
Department of Orthopaedics, Orthopaedic Specialty Hospital, Mercy Medical Center, Baltimore, Maryland, United States.
J Orthop Case Rep. 2021 Jun;11(6):102-105. doi: 10.13107/jocr.2021.v11.i06.2278.
Dysbaric osteonecrosis (DON) is a specific type of atraumatic osteonecrosis that has been shown to occur mainly in deep-sea divers and workers exposed to increased air pressure environments. The pathophysiology is not entirely understood but is thought to be due to subclinical decompression sickness resulting in arterial gas emboli. This leads to vascular occlusion and subsequent bone death.
An active 56-year-old male diver presented with progressive bilateral shoulder pain and dysfunction due to bilateral DON of the humeral head and associated posterosuperior rotator cuff tearing. The diagnosis was confirmed by physical examination, X-rays, and magnetic resonance imaging. Due to failure of conservative treatment, a single-stage bilateral, subscapularis-sparing, stemless shoulder hemiarthroplasty with concomitant rotator cuff repair was performed. At 24-month follow-up, the patient showed satisfactory functional outcomes in both shoulders without complication.
This single-stage surgical treatment is an exceptional indication for a bilateral dysbaric humeral head osteonecrosis that can be considered in selected cases because may reduce the total recovery time and can be safe and effective at 24 months postoperatively.
减压性骨坏死（DON）是一种特殊类型的非创伤性骨坏死，主要发生在深海潜水员和暴露于气压升高环境的工人中。其病理生理学尚未完全明确，但被认为是由于亚临床减压病导致动脉气体栓塞，进而引起血管阻塞和随后的骨坏死。
一名56岁的活跃男性潜水员因双侧肱骨头减压性骨坏死及相关的后上肩袖撕裂，出现双侧肩部进行性疼痛和功能障碍。通过体格检查、X线和磁共振成像确诊。由于保守治疗失败，进行了一期双侧、保留肩胛下肌、无柄肩关节半关节置换术并同时修复肩袖。在24个月的随访中，患者双肩功能结果令人满意，无并发症。
这种一期手术治疗是双侧减压性肱骨头骨坏死的一种特殊适应证，在某些特定病例中可以考虑采用，因为它可能会缩短总恢复时间，并且在术后24个月时是安全有效的。
