Department of Orthopaedics, Wuxi 9Th People's Hospital Affiliated to Soochow University, NO.999 Liangxi Road, Wuxi, China.
Orthopaedic Institute, Medical College, Soochow University, NO.178 Ganjiang East Road, Suzhou, China.
BMC Musculoskelet Disord. 2023 Feb 11;24(1):114. doi: 10.1186/s12891-023-06221-3.
Posterior shoulder dislocation is an uncommon orthopaedics injury and is frequently missed or misdiagnosed, accounting for 2%-4% of all shoulder dislocations, and is associated with the reverse Hill-Sachs lesion. Once posterior shoulder dislocation develops into a chronic disease, it will bring a lot of trouble to the treatment, especially in repairing the humeral defects. Surgical strategies are also developing and innovating to deal with this injury, including transfer of subscapularis tendon or lesser tubercle, humeral rotational osteotomy, autogenous bone graft or allograft. Shoulder replacement seems to be the ultimate and only option when the injury becomes irreparable, although some studies have shown unsatisfactory follow-up results. Considering no gold-standard treatment for locked posterior shoulder dislocation, we described a novel modified McLaughlin procedure for locked chronic posterior shoulder dislocation and evaluated the functional outcomes.
This study included five locked chronic posterior shoulder dislocation patients with an associated reverse Hill-Sachs lesion, in which the compression surface covered 30-40% of the humeral head. The mean period from injury to receiving surgery was 11.6 weeks (6-24 weeks). All five patients underwent the modified McLaughlin procedure, mainly divided into three steps, including open reduction, transfer of the partial lesser tuberosity and artificial bone to repair the reverse Hill-Sachs defects. The kernel technique was to fix the transferred tuberosity with two lag screws and strengthen it with two Ethibond sutures. The Constant-Murley score (CMS), the range of shoulder motion and the complications were recorded to assess and compare the functional situation of the shoulder postoperatively and postoperatively.
After an average of 19.8 months (12-30) of follow-up, the mean CMS improved to 85.8 ± 4.9 (79-91) compared with 46.0 ± 4.5 (40-52) preoperatively, which showed a significant difference (p = 0.001). In the final follow-up, all five patients showed no symptoms of shoulder instability, and there was no pain or limited activity in daily life, thus all patients were satisfied with the results.
Repairing the reverse Hill-Sachs lesion by transferring the partial lesser tuberosity combined with artificial bone fixed by lag screws and sutures can ensure shoulder stability and provide pain relief and good function in patients with locked chronic posterior shoulder dislocation associated with the humeral head defect.
后肩脱位是一种不常见的骨科损伤，经常被漏诊或误诊，占所有肩脱位的 2%-4%，并与反向 Hill-Sachs 病变有关。一旦后肩脱位发展成慢性病，治疗将会带来很多麻烦，尤其是在修复肱骨头缺陷方面。为了应对这种损伤，手术策略也在不断发展和创新，包括肩胛下肌腱或小结节转移、肱骨旋转截骨术、自体骨移植或同种异体骨移植。当损伤无法修复时，肩关节置换似乎是最终的、唯一的选择，尽管一些研究显示其随访结果并不理想。考虑到没有治疗锁定性后肩脱位的金标准，我们描述了一种新型改良 McLaughlin 手术治疗锁定性慢性后肩脱位，并评估了其功能结果。
本研究纳入了 5 例伴有反向 Hill-Sachs 病变的锁定性慢性后肩脱位患者，其中压缩面覆盖肱骨头的 30%-40%。从受伤到接受手术的平均时间为 11.6 周（6-24 周）。所有 5 例患者均接受改良 McLaughlin 手术，主要分为三个步骤，包括切开复位、部分小结节转移和人工骨修复反向 Hill-Sachs 缺陷。核心技术是用 2 枚拉力螺钉固定转移的小结节，并使用 2 根 Ethibond 缝线进行加强。记录Constant-Murley 评分（CMS）、肩关节活动范围和并发症，以评估和比较术后和随访时肩关节的功能情况。
平均随访 19.8 个月（12-30 个月）后，CMS 平均改善至 85.8±4.9（79-91），术前为 46.0±4.5（40-52），差异有统计学意义（p=0.001）。末次随访时，所有 5 例患者均无肩关节不稳定症状，日常生活中无疼痛或活动受限，均对结果满意。
通过转移部分小结节并用拉力螺钉和缝线固定人工骨修复反向 Hill-Sachs 病变，可以确保肩关节稳定性，并为伴有肱骨头缺陷的锁定性慢性后肩脱位患者提供疼痛缓解和良好的功能。
