Sahu Dipit, Gupta Sonam
Mumbai Shoulder Institute, Mumbai; Jupiter Hospital, Thane; Sir H.N. Reliance Foundation Hospital, Mumbai, Maharashtra, India.
Mumbai Shoulder Institute, Mumbai, Maharashtra, India.
JSES Int. 2023 Oct 5;8(1):11-20. doi: 10.1016/j.jseint.2023.09.003. eCollection 2024 Jan.
Neglected and locked anterior shoulder dislocation is a rare problem that presents several treatment challenges. Our study aimed to evaluate the functional outcomes and postoperative complications after open reduction and head preservation surgery in patients with neglected and locked anterior shoulder dislocation.
Ten patients (age 51 ± 22 years) with a follow-up of 27 months ± 7 months (range 24-40 months) were included in the study. The anteriorly dislocated humeral heads were open and reduced after an average neglect of 10 ± 15 months. The neglected dislocation was classified into two types by the severity of the injury. (1) Type 1: There were no associated severe injuries, and the humeral head was reduced in the glenoid cavity without take-down of the subscapularis (type 1a) (n = 5) or via take-down of the upper half of the subscapularis (type 1b) (n = 2). (2) Type 2: There were associated factors such as a greater tuberosity fracture (n = 2) or a grade 3/4 fatty infiltrated supraspinatus and infraspinatus muscles (n = 1). Complete removal of the subscapularis was necessary to reduce the humeral head.
The pain scores improved from a baseline value of 8 ± 1 to a final value of 1 ± 1 ( < .001), the absolute Constant score improved from a baseline value of 13 ± 8 to a final value of 69 ± 21 ( < .001), elevation range of motion (ROM) improved from a baseline value of 44° ± 43° to a final value of 123° ± 30° ( < .001), external rotation ROM improved from 0° ± 13° to 49° ± 12° ( < .001), and internal rotation ROM improved from sacroiliac joint ± 2 vertebra level to thoracic T11 ± 3 vertebrae level ( < .0001). The final shoulder subjective value was 77 ± 20 and was excellent in 3 patients, good in 5 patients, fair in 1, and poor in 1 patient. Major complications were observed in 30% (n = 3) of patients: persistent humeral head anterior subluxation in 20% (n = 2) of patients and superior migration of the humeral head in 10% (n = 1) of patients.
Open reduction and head preservation in patients with neglected anterior dislocation led to good functional outcomes in 70% (as per Constant score) to 80% (as per shoulder subjective value) of the patients. However, we observed major complications such as persistent anterior subluxation (n = 2) and superior head migration (n = 1), leading to suboptimal functional outcomes in cases with associated factors such as a greater tuberosity fracture or severe fatty infiltrated cuff muscles.
被忽视的锁定性肩关节前脱位是一个罕见问题，存在多种治疗挑战。我们的研究旨在评估被忽视的锁定性肩关节前脱位患者行切开复位及保留肱骨头手术后的功能结局和术后并发症。
本研究纳入10例患者（年龄51±22岁），随访时间为27个月±7个月（范围24 - 40个月）。平均在被忽视10±15个月后，对前脱位的肱骨头进行切开复位。根据损伤严重程度将被忽视的脱位分为两种类型。（1）1型：无相关严重损伤，肱骨头在未切断肩胛下肌的情况下复位至关节盂内（1a型）（n = 5）或通过切断肩胛下肌上半部分复位（1b型）（n = 2）。（2）2型：存在相关因素，如大结节骨折（n = 2）或冈上肌和冈下肌脂肪浸润达3/4级（n = 1）。为了复位肱骨头，必须完全切断肩胛下肌。
疼痛评分从基线值8±1改善至最终值1±1（P <.001），Constant绝对评分从基线值13±8改善至最终值69±21（P <.001），活动度（ROM）抬高从基线值44°±43°改善至最终值123°±30°（P <.001），外旋ROM从0°±13°改善至49°±12°（P <.001），内旋ROM从骶髂关节±2椎体水平改善至胸11椎体±3椎体水平（P <.0001）。最终肩关节主观评分为77±20，其中3例为优，5例为良，1例为可，1例为差。30%（n = 3）的患者出现主要并发症：20%（n = 2）的患者出现肱骨头持续性前半脱位，10%（n = 1）的患者出现肱骨头向上移位。
对于被忽视的肩关节前脱位患者，切开复位及保留肱骨头手术使70%（根据Constant评分）至80%（根据肩关节主观评分）的患者获得了良好的功能结局。然而，我们观察到了主要并发症，如持续性前半脱位（n = 2）和肱骨头向上移位（n = 1），在存在大结节骨折或严重脂肪浸润的肩袖肌肉等相关因素的病例中，导致功能结局欠佳。
