Groh G I, Williams G R, Jarman R N, Rockwood C A
Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, 78284, USA.
J Bone Joint Surg Am. 1997 Jun;79(6):881-7. doi: 10.2106/00004623-199706000-00012.
A reconstructive osteotomy was performed to correct symptomatic malposition after arthrodesis of the shoulder in nine of fourteen patients who had complications related to the arthrodesis. The clinical position of the arm in relation to the trunk was determined with the method described by Rowe. Malposition was primarily the result of fusion in more than 15 degrees of either flexion or abduction, or both, coupled with improper rotation, defined as rotation of less than 40 degrees or more than 60 degrees. Reconstructive osteotomy eliminated pain and improved the ability of the patient to perform six activities of daily living. The complications necessitating operative treatment after the arthrodesis in the remaining five patients included failure of the arthrodesis site to unite (three patients), a wound hematoma at the iliac-crest donor site (one patient), and a superficial wound infection (one patient). Two additional complications - a fracture through a screw-hole in the humerus and a fracture distal to the internal fixation device - occurred after the reconstructive osteotomies for malposition. All of the complications resolved with treatment. Arthrodesis of the shoulder is a technically demanding procedure that can lead to serious complications that necessitate operative intervention. Careful attention to operative technique and to the position of the arthrodesis are essential.
在14例与肩关节融合术相关并发症的患者中，有9例进行了重建截骨术，以纠正肩关节融合术后出现症状的位置异常。采用Rowe描述的方法确定手臂相对于躯干的临床位置。位置异常主要是由于在屈曲或外展15度以上或两者皆有的情况下融合，再加上旋转不当，定义为旋转小于40度或大于60度。重建截骨术消除了疼痛，并提高了患者进行六项日常生活活动的能力。其余5例患者在肩关节融合术后需要手术治疗的并发症包括融合部位不愈合（3例）、髂嵴供区伤口血肿（1例）和浅表伤口感染（1例）。另外还有两种并发症——肱骨螺钉孔处骨折和内固定装置远端骨折——发生在因位置异常进行重建截骨术后。所有并发症经治疗后均得到解决。肩关节融合术是一项技术要求很高的手术，可能会导致严重并发症，需要进行手术干预。仔细关注手术技术和融合位置至关重要。
