Hu Yongrong, Yang Kunhai, Liu Hao, Wang Liping, Wang Song, Zhang Xiang, Qu Bo, Yang Hongsheng
Department of Orthopedics, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province, China.
Front Bioeng Biotechnol. 2023 Oct 9;11:1259255. doi: 10.3389/fbioe.2023.1259255. eCollection 2023.
Irregular bone defects of the humerus are common in clinical practice, but there are fewer reported cases of irregular humeral defects accompanied by shoulder joint "locking" dislocation and reverse Hill-Sachs injury caused by an electric shock. The choice of treatment for such cases is closely related to the extent of shoulder joint function recovery. This is a case report of a 60-year-old male patient who suffered from a shoulder joint "locking" dislocation with accompanying reverse Hill-Sachs injury due to muscle contraction after being electrically shocked at work. The patient was treated with a 3D-printed custom humeral head prosthesis for the treatment of the shoulder joint "locking" dislocation and reverse Hill-Sachs injury. A 60-year-old male patient, working as a construction worker, presented to our emergency department with right shoulder pain and restricted movement for more than 30 min after an electric shock. Right humeral CT revealed a comminuted fracture of the right humeral head. D-dimer levels were significantly elevated at 3239.00 ng/mL, and oxygen partial pressure was slightly decreased at 68 mmHg. Treatment included emergency wound debridement and dressing for the electrical injury, cardioprotective measures, anticoagulation, and symptomatic management. After stabilizing the patient's condition, the patient underwent 3D-printed custom prosthesis-assisted partial replacement of the right humeral head and rotator cuff repair in the orthopedic department. Postoperatively, the patient's right shoulder joint wound healed well, and mobility was restored. This case report demonstrates that the use of a 3D-printed custom prosthesis for the treatment of irregular humeral bone defects caused by specific injury mechanisms, especially cases involving shoulder joint "locking" dislocation and reverse Hill-Sachs injury, can achieve precise bone defect repair, minimize surgical trauma, and provide superior outcomes in terms of postoperative functional rehabilitation.
肱骨不规则骨缺损在临床实践中较为常见,但因电击导致肱骨不规则缺损并伴有肩关节“锁定”脱位及反 Hill-Sachs 损伤的病例报道较少。此类病例的治疗选择与肩关节功能恢复程度密切相关。本文报告一例 60 岁男性患者,其在工作中触电后因肌肉收缩导致肩关节“锁定”脱位并伴有反 Hill-Sachs 损伤。该患者接受了 3D 打印定制肱骨头假体治疗肩关节“锁定”脱位及反 Hill-Sachs 损伤。一名 60 岁男性建筑工人在触电后右肩疼痛、活动受限 30 余分钟,就诊于我院急诊科。右肱骨 CT 显示右肱骨头粉碎性骨折。D-二聚体水平显著升高至 3239.00 ng/mL,氧分压略有下降至 68 mmHg。治疗包括对电损伤进行紧急伤口清创和包扎、心脏保护措施、抗凝及对症处理。待患者病情稳定后,在骨科接受了 3D 打印定制假体辅助下的右肱骨头部分置换及肩袖修复术。术后,患者右肩关节伤口愈合良好,活动功能得以恢复。本病例报告表明,使用 3D 打印定制假体治疗由特定损伤机制导致的肱骨不规则骨缺损,尤其是涉及肩关节“锁定”脱位及反 Hill-Sachs 损伤的病例,能够实现精确的骨缺损修复,将手术创伤降至最低,并在术后功能康复方面取得较好效果。