Ebied Wessam Fakhery, Younis Ahmed Saeed, Hemida Mohamed Amr, Khater Ahmed H, Haroun Yahia
Orthopedic Department, Faculty of Medicine, Ain Shams University, 38 Abbassia, next to the Al-Nour Mosque, 11566 Cairo, Egypt - Orthopedic Surgery, Ain Shams University, 38 Abbassia, next to the Al-Nour Mosque, 11566 Cairo, Egypt.
SICOT J. 2024;10:53. doi: 10.1051/sicotj/2024050. Epub 2024 Dec 3.
Posterior shoulder dislocation with a reverse Hill-Sachs lesion is a rare and complex injury, requiring specialized treatment due to the difficulty in diagnosis, reduction, and addressing both sides of the pathology to reduce the potential for recurrent dislocation.
To evaluate the clinical and functional outcomes of closed reduction and arthroscopic McLaughlin procedure with posterior labral repair in patients with neglected locked posterior shoulder dislocation for less than 12 weeks.
A prospective study was conducted at university hospitals, managing 15 patients with neglected locked posterior shoulder dislocation for less than 12 weeks and concomitant engaging reverse Hill-Sachs lesions of less than 40% of the humeral articular surface. They were treated with closed reduction and arthroscopic McLaughlin procedure with posterior labral repair. Patients' assessments included shoulder range of motion, pain levels using the visual analog scale (VAS) score, and functional outcome using the Oxford instability score and the University of California Los Angeles Shoulder Scale (UCLA) with at least 2 years of postoperative follow-up.
All 15 patients reported no recurrent dislocation and restored shoulder motion at the final follow-up. External rotation significantly improved from 0° to a mean of 65° in adduction, at 90° of abduction, the respective measurement was 85° (p < 0.01). Active forward flexion increased from 35° to 145° (p < 0.01). UCLA and Oxford instability scores Showed marked improvement (p < 0.01).
Closed reduction and arthroscopic McLaughlin procedure with posterior labral repair is a safe and effective way for managing patients with locked neglected posterior shoulder dislocations that have been neglected for less than 12 weeks with engaging reverse Hill-Sachs lesion defect, less than 40% of the humeral head.
伴有反向希尔-萨克斯损伤的肩关节后脱位是一种罕见且复杂的损伤，由于诊断、复位困难，以及需要处理病理损伤的双侧以降低复发性脱位的可能性，因此需要进行专门治疗。
评估在12周内被忽视的锁定性肩关节后脱位患者中，采用闭合复位和关节镜下麦克劳林手术并修复后盂唇的临床和功能结果。
在大学医院进行了一项前瞻性研究，治疗15例被忽视的锁定性肩关节后脱位患者，病程少于12周，同时伴有小于肱骨关节面40%的嵌顿性反向希尔-萨克斯损伤。他们接受了闭合复位和关节镜下麦克劳林手术并修复后盂唇。患者评估包括肩关节活动范围、使用视觉模拟量表（VAS）评分的疼痛程度，以及使用牛津不稳定评分和加利福尼亚大学洛杉矶分校肩关节评分（UCLA）的功能结果，术后随访至少2年。
所有15例患者在最终随访时均未出现复发性脱位，肩关节活动得以恢复。内收位时，外旋从0°显著改善至平均65°，外展90°时，相应测量值为85°（p < 0.01）。主动前屈从35°增加至145°（p < 0.01）。UCLA和牛津不稳定评分显示出显著改善（p < 0.01）。
闭合复位和关节镜下麦克劳林手术并修复后盂唇是治疗被忽视的锁定性肩关节后脱位患者的一种安全有效的方法，这些患者病程少于12周，伴有小于肱骨头40%的嵌顿性反向希尔-萨克斯损伤缺损。
