Shevate Ishan, Salunkhe Rahul, Kulkarni Ketan, Janapamala Kishore, Deshmukh Ashwin
Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND.
Cureus. 2023 Jan 29;15(1):e34356. doi: 10.7759/cureus.34356. eCollection 2023 Jan.
A Hill-Sachs lesion, a posterolateral bony defect of the proximal humerus, occurs when the humerus head collides with the anterior region of the glenoid during an anterior shoulder dislocation. A posteriorly dislocated shoulder may cause a reverse Hill-Sachs lesion, which is a deficiency on the anteromedial part of the humeral head due to impaction. Avascular necrosis could result from this lesion if detection and repair are not carried out. The subscapularis tendon is separated from the smaller tuberosity using an open technique in the original McLaughlin procedure, which was initially described in 1952. In neglected cases of patients undergoing surgery after three weeks, there is no commonly accepted standard of care. Glenohumeral joint stabilization and early and full functional recovery are the two objectives of the procedure. This case report describes a modified McLaughlin surgery where the subscapularis tendon and lesser tuberosity are transferred to the reverse Hill-Sachs defect for stability. The clinical significance of our case report is that it accentuates the role of early detection and appropriate management of reverse Hill-Sachs lesion, which is often overlooked and missed in a case of posterior shoulder dislocation. The use of the modified McLaughlin procedure not only covers the defect with a bone chunk and the subscapularis tendon transfer over the head of the humerus but the stable fixation with the anchor and cannulated cancellous screw helps in early rehabilitation of the shoulder joint.
希尔-萨克斯损伤是肱骨近端的后外侧骨质缺损，当肩关节前脱位时，肱骨头与肩胛盂前部碰撞就会发生这种损伤。后脱位的肩关节可能会导致反希尔-萨克斯损伤，即由于撞击导致肱骨头内侧前部出现缺损。如果未进行检测和修复，这种损伤可能会导致缺血性坏死。在最初于1952年描述的原始麦克劳林手术中，采用开放技术将肩胛下肌腱从小结节分离。对于受伤三周后接受手术的被忽视病例，目前尚无普遍接受的护理标准。肩关节稳定及早期和完全功能恢复是该手术的两个目标。本病例报告描述了一种改良的麦克劳林手术，即将肩胛下肌腱和小结节转移至反希尔-萨克斯缺损处以实现稳定。我们病例报告的临床意义在于，它强调了早期发现和适当处理反希尔-萨克斯损伤的作用，这种损伤在肩关节后脱位病例中常常被忽视和漏诊。改良的麦克劳林手术不仅用一块骨块覆盖缺损，并将肩胛下肌腱转移至肱骨头上方，而且使用锚钉和空心松质骨螺钉进行稳定固定有助于肩关节的早期康复。
