University of Central Florida College of Medicine, Orlando, FL, USA.
Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA.
Orthop Surg. 2023 Jul;15(7):1730-1741. doi: 10.1111/os.13758. Epub 2023 Jun 1.
Locked shoulder dislocations account for up to 5% of shoulder dislocations. These relatively rare injuries are characterized by dislocation of the humeral head from the scapular glenoid cavity with the humeral head incarcerated on the glenoid in a "locked" fashion. Diagnosis is often delayed because of the complexity of clinical presentation and subtle radiographic findings, resulting in locking of the humeral head out of the glenoid cavity with severe functional deficits. Most commonly, there are bony injuries to the glenoid and humeral head that engage and prevent closed reduction. Since few patients present with this injury, evidence-based treatment guidelines have not been established. The objective of this review is to assess postoperative outcomes following shoulder arthroplasty for locked posterior shoulder dislocations (LPSD) to guide best practices for treatment. This systematic review was conducted following PRISMA guidelines, searching the PubMed and Web of Science databases for original articles assessing outcomes following arthroplasty for locked posterior shoulder dislocations. Seven publications that evaluated 102 patients were included. Additionally, nine case studies were included, assessing 20 shoulder arthroplasties. Overall, the analysis demonstrated significant improvement in shoulder pain following total shoulder arthroplasty (TSA) (P = 0.0003). Older operative patient ages for TSA resulted in significantly improved modified Neer outcomes scores and patient satisfaction compared to younger patients (P = 0.047). A positive correlation was noted for the duration of dislocation and necessity for revision surgery following hemiarthroplasty (HSA) and TSA combined and TSA separately. The risk ratios assessing the incidence of postoperative complications (RR = 0.56, 95% CI = 0.28-1.11) and necessity for revision surgery (RR = 0.58, 95% CI = 0.24-1.39) were insignificant but noted outcomes favoring TSA. Data from the included studies show that both TSA and HSA are efficacious at treating locked posterior shoulder dislocation. Postoperative outcomes following TSA versus HSA are similar. TSA may be a more efficacious surgical treatment in elderly patients, with improved outcomes and patient satisfaction scores compared to younger patients. Early diagnosis and treatment of posterior locked dislocations may lead to reduced postoperative complications and revision surgery, signaling the importance of proper injury investigation and early treatment. The role of RSA in the management of locked posterior shoulder dislocation remains to be determined, as there is insufficient clinical outcome data currently in the literature.
锁定肩脱位占肩部脱位的 5%。这些相对罕见的损伤的特征是肱骨头从肩胛盂窝脱位，肱骨头以“锁定”的方式嵌在肩胛盂上。由于临床表现复杂和细微的影像学发现，诊断常常被延误，导致肱骨头锁定在肩胛盂外，伴有严重的功能缺损。最常见的是肩胛盂和肱骨头有骨损伤，这些损伤会嵌合并防止闭合复位。由于很少有患者出现这种损伤，因此尚未制定基于证据的治疗指南。本综述的目的是评估锁定性后肩脱位（LPSD）行肩关节置换术后的术后结果，以指导治疗的最佳实践。本系统评价遵循 PRISMA 指南，在 PubMed 和 Web of Science 数据库中搜索评估锁定性后肩脱位关节成形术后结果的原始文章。纳入了 7 项评估 102 例患者的研究。此外，还纳入了 9 项病例研究，评估了 20 例肩关节置换术。总体而言，分析表明全肩关节置换术（TSA）后肩关节疼痛显著改善（P=0.0003）。与年轻患者相比，TSA 手术中患者年龄较大，改良 Neer 结果评分和患者满意度显著提高（P=0.047）。半肩关节置换术（HSA）和 TSA 联合及 TSA 单独治疗后，脱位时间与翻修手术的必要性之间存在正相关。评估术后并发症发生率（RR=0.56，95%CI=0.28-1.11）和翻修手术必要性（RR=0.58，95%CI=0.24-1.39）的风险比无统计学意义，但 TSA 治疗结果更优。纳入研究的数据表明，TSA 和 HSA 均能有效治疗锁定性后肩脱位。TSA 与 HSA 术后结果相似。与年轻患者相比，TSA 可能是治疗老年患者的更有效手术治疗方法，可改善术后结果和患者满意度评分。早期诊断和治疗后锁定位脱位可能会减少术后并发症和翻修手术，这表明适当的损伤调查和早期治疗的重要性。目前文献中缺乏 RSA 在锁定性后肩脱位治疗中的作用的数据，因此 RSA 在管理锁定性后肩脱位中的作用仍有待确定。
