Sonnabend D H
Department of Traumatic & Orthopaedic Surgery, Prince of Wales Hospital, Randwick, Australia.
Clin Orthop Relat Res. 1994 Jul(304):74-7.
Primary shoulder dislocation in patients older than 40 years of age is frequently benign, but may be associated with significant rotator cuff or nerve injury. A series of such patients was observed to determine an effective treatment algorithm. Treatment of those dislocations associated with fractures of the greater tuberosity was determined by the fracture pattern. Four patients with glenoid fractures were all treated operatively. Patients without associated fractures were classified according to the absence or presence of significant pain or weakness after 3 weeks. Of 27 patients who were symptom free at 3 weeks, only four had associated problems after 3 months. All of 13 patients complaining of weakness or pain after 3 weeks had significant associated lesions (11 rotator cuff tears, 2 cuff tears plus neurologic deficit). The persistence of significant pain or weakness 3 weeks after primary dislocation in this age group is an indication for further investigation (arthrography or ultrasound). While recurrent instability is relatively uncommon, rotator cuff repair when appropriate in medically fit patients resulted in pain relief and return of strength.
40岁以上患者的原发性肩关节脱位通常为良性，但可能伴有严重的肩袖或神经损伤。观察了一系列此类患者以确定有效的治疗方案。与大结节骨折相关的脱位的治疗取决于骨折类型。4例肩胛盂骨折患者均接受了手术治疗。无相关骨折的患者根据3周后是否存在明显疼痛或无力进行分类。在27例3周时无症状的患者中，只有4例在3个月后出现相关问题。13例在3周后抱怨无力或疼痛的患者均有明显的相关病变（11例肩袖撕裂，2例肩袖撕裂加神经功能缺损）。在这个年龄组中，初次脱位3周后持续存在明显疼痛或无力是进一步检查（关节造影或超声）的指征。虽然复发性不稳定相对不常见，但在身体状况适合的患者中，适时进行肩袖修复可缓解疼痛并恢复力量。
