Postacchini F, Facchini M
1st Orthopaedic Clinic, La Sapienza University, Rome.
Ital J Orthop Traumatol. 1987 Mar;13(1):15-26.
The clinical and radiographic features and the results of treatment are analysed in 12 cases of shoulder dislocation (5 anterior and 7 posterior) in which the dislocation had been present for periods ranging from 3 weeks to 6 months. The follow-up ranged from 9 months to 16 years. Anterior dislocations are easily diagnosed on anteroposterior radiographs. Posterior dislocations may be suspected clinically because of the position of the limb in internal rotation and loss of external rotation, but can easily be missed on A.P. films, which show only a flattened appearance of the humeral head. A definite diagnosis is obtained only with a lateral (axillary) projection. All the anterior dislocations in our series were uncomplicated, but 4 of the posterior dislocations were associated with fractures of the humeral head and/or the greater tuberosity. Two of the 5 anterior dislocations were treated with physiotherapy and remedial exercises alone, while 2 were successfully reduced by manipulation; in the only patient submitted to surgery, ablation of the humeral head was performed. Results were excellent in one of the 2 patients treated with physiokinesitherapy where dislocation had been reduced spontaneously (the only such case described in the literature), and in one of the two cases submitted to nonoperative reduction of the dislocation. Results were good in the second patient subjected to nonoperative reduction and in the patient operated on. All 7 cases of posterior dislocation were treated surgically: in 3 cases the dislocation was reduced, in one the humeral head was removed, in one a partial shoulder prosthesis was applied, and in 2 cases the whole of the proximal extremity of the humerus was resected. In the latter 2 cases the results were poor and fair respectively, while in the remaining cases the results were good. The best surgical treatment of inveterate dislocations is reduction of the dislocation, which in the posterior forms requires a wide antero-supero-posterior approach. The alternative to surgical reduction is the application of a shoulder prosthesis, the result of which (as in resection of the humeral head) is related to the integrity of the greater tuberosity and the rotator cuff.
分析了12例肩关节脱位患者（5例前脱位和7例后脱位）的临床和影像学特征及治疗结果，这些脱位持续时间为3周至6个月。随访时间为9个月至16年。前脱位在前后位X线片上易于诊断。后脱位临床上可能因肢体处于内旋位且外旋丧失而被怀疑，但在前后位片上很容易漏诊，前后位片上仅显示肱骨头扁平外观。只有通过侧位（腋窝）投照才能获得明确诊断。我们系列中的所有前脱位均无并发症，但4例后脱位合并肱骨头和/或大结节骨折。5例前脱位中有2例仅接受物理治疗和康复锻炼，2例通过手法复位成功；在唯一接受手术的患者中，进行了肱骨头切除术。在2例接受物理运动疗法治疗的患者中，1例脱位已自行复位（文献中描述的唯一此类病例），另1例接受脱位非手术复位，结果均为优。接受非手术复位的第2例患者和接受手术的患者结果为良。所有7例后脱位均接受手术治疗：3例脱位得以复位，1例切除肱骨头，1例应用部分肩关节假体，2例切除肱骨近端全部。后2例结果分别为差和中，其余病例结果为良。陈旧性脱位的最佳手术治疗是脱位复位，后脱位形式需要广泛的前上后入路。手术复位的替代方法是应用肩关节假体，其结果（与肱骨头切除一样）与大结节和肩袖的完整性有关。
