闭合复位治疗肩关节前脱位合并肱骨颈骨折

闭合复位治疗肩关节前脱位合并肱骨颈骨折广州市中医医院（５１０１３０）钟正仁作者自１９７９年至今治疗１０例肩关节前脱位合并肱骨颈骨折，８例闭合复位获得成功。现报告如下。临床资料１０例中男４例，女６例；年龄１３～６４岁；喙突下脱位３例，盂下脱位５例，锁骨...     

肩关节前脱位并肱骨外科颈骨折的闭合复位治疗

肩关节前脱位并肱骨外科颈骨折的闭合复位治疗广东省佛山市中医院（５２８０００）陈志维，钟广玲，陈渭良笔者于１９８０～１９９２年采用闭合性手法整复，小夹板固定治疗肩关节前脱位并肱骨外科颈骨折１９例取得较好效果，报告如下。临床资料本组１９例，男８例，女１１...     

手法整复肱骨外科颈骨折合并肩关节前脱位

手法整复肱骨外科颈骨折合并肩关节前脱位哈尔滨市大成医院（１５００１０）夏仲贤，周莉丽，孙巍，孙广肱骨外科颈骨折合并肩关节前脱位是一种少见而又严重的创伤，闭合复位极为困难，我院收治２６例，采用手法整复，小夹板外固定的方法，取得满意的效果，现报告如下临床...     

高龄肩关节前脱位合并肱骨解剖颈骨折的治疗

目的探讨肩关节前脱位合并肱骨解剖颈骨折的治疗方法和疗效。方法 20例肩关节前脱位合并肱骨解剖颈骨折患者中,手法复位成功外展架固定3例,切开复位内固定15例,人工肱骨头置换术2例。结果20例均获随访,时间7～22个月。手法复位成功外展架固定3例均有不同程度的关节功能障碍;切开复位锁定解剖钢板固定、术后外展架固定15例中,12例肩关节功能恢复正常,3例肩关节功能轻度受限;2例肱骨头置换术者肩关节功能基本正常。结论肩关节前脱位合并肱骨解剖颈骨折,若无手术禁忌,宜采用切开复位锁定解剖钢板内固定、术后外展架固定,肩关节功能恢复良好。     

上举牵引法整复肩关节脱位

1986年1月～1993年10月,作者用上举牵引法顺利整复36例肩关节脱位.临床资料 男29例,女7例.年龄15～59岁.肩关节前脱位35例,其中习惯性脱位2例,难复性肩关节脱位4例;肩关节后脱位1例.合并肱骨大结节骨折5例,肱骨外科颈骨折2例.整复方法 一般不用麻醉,个别肿痛严重者关节腔内注入普鲁卡因局麻.患者仰卧在复位床上,术者站在其头侧床旁,用一足蹬在患肩,双手握患侧手腕将患肢置     

内固定治疗肱骨近端复杂骨折并肩关节前脱位

目的 探讨开放复位肱骨近端锁定钢板及不可吸收粗缝线固定肱骨近端复杂骨折并肩关节前脱位的疗效.方法 本组11例肱骨近端复杂骨折并肩关节前脱位患者,均行开放复位内固定,手术取三角肌胸大肌间隙入路.采用锁定钢板固定肱骨头与干骺端骨折,使用不可吸收粗缝线张力带固定大小结节.结果 平均随访13个月(8～26个月),术后功能采用Constant-Murley评分法进行评估,平均评分为80.5分(56～94分),优63.6%(7/11),可18.1%(2/11),差为18.1%(2/11),X线片随访将肱骨头缩小,部分吸收,完全吸收均诊断为肱骨头坏死,其中Neer三部分骨折并肩关节前脱位肱骨头坏死率为16.7%(1/6),Neer四部分骨折并肩关节前脱位肱骨头坏死率为60%(3/5).结论 复杂肱骨近端骨折并肩关节前脱位手术解剖复位锁定钢板及不可吸收粗缝线有效固定,辅以适当的功能锻炼,可取得良好疗效.     

反Hippocrates法治疗肩关节脱位及肱骨外科颈骨折

1986年1月～1995年1月,我们采用反Hippocrates手法顺利复位肩关节脱位、肱骨外科颈骨折及二者并存共计53例,介绍如下。 临床资料 一、一般资料:男40例,女性13例。年龄15岁～70岁。肩关节脱位36例,其中前脱位35例,后脱位者1例,并肱骨大结节骨折5例,两次以上脱位者6例,难复性肩关节脱位5例。肱骨外科颈骨折15例,内收型7例,外展型8型,肩关节脱位并肱骨外科颈骨折2例。复位时间伤后3小时～7天。     

两例医源性肱骨近端骨折的治疗并文献复习

目的探讨2例医源性肱骨近端骨折的治疗经验,并结合文献复习分析医源性肱骨近端骨折的成因。方法我科分别于2018年1月和2019年1月收治了2例医源性肱骨近端骨折病人,均采用近端锁定钢板固定术治疗,术后随访采用肩关节Neer评分系统评价肩关节功能。结果术后复查病人肩关节X线片示肩关节形态、间隙及位置关系良好,内固定及假体位置良好;术后半年,肩关节Neer评分1例为优,1例为良。结论对于肩关节前脱位的病人,特别是合并肱骨近端裂缝骨折的病人,盲目粗暴手法复位往往造成医源性肱骨近端骨折,应提高对医源性肱骨近端骨折的认识,以减少其发生。     

手法整复经皮导入空心加压螺纹钉内固定治疗肱骨近端骨折脱位

目的：介绍一种治疗新鲜肱骨近端骨折脱位的闭合整复和半开放手术方法,并对其疗效进行评价。方法：对43例肱骨近端骨折合并肩关节前脱位患者应用反“？”手法整复骨折,经皮导入空心螺纹钉内固定后按单纯肩关节前脱位整复治疗。术后2年进行肩关节Neer评分。结果：术后针眼无感染,均工期愈合。螺纹钉无折断。骨折均在术后2个月内愈合。经24～52个月的随访,无肱骨头坏死发生。疗效优35例,良7例,可1例,优良率为97．7％。结论：反“？”手法设计合理,复位率高。经皮导入内固定可靠,无须外固定,术后可早期活动肩关节,有效预防了关节粘连,较好地保护了肱骨头的血供,避免了肱骨头缺血性坏死的发生。     

俯卧位推按肩胛骨整复肩关节前脱位合并肱骨外髁颈骨折

目的为肩关节前脱位合并肱骨外髁颈骨折寻求新的闭合复位方法.方法本组6例患者,男4例,女2例,平均年龄42.5岁.受伤至整复时间平均3.5 h.俯卧位,一手握拳顶住肱骨头,另一手推按肩胛骨整复,透视下整复肱骨外髁颈骨折,超肩小夹板固定3周,所有病例复位成功.结果本组6例均获随访.采用Neer评定标准,优4例,满意2例,不满意为0.结论肩关节前脱位合并肱骨外髁颈骨折可以采用俯卧位推按肩胛骨获得成功,肩关节功能恢复满意.     

人工肱骨头置换治疗老年肱骨近端三、四部分骨折

目的 探讨老年肱骨近端三、四部分骨折行人工肱骨头置换术的适应证、技术要点及术后康复治疗对肩关节功能恢复的影响.方法 对15例老年肱骨近端三、四部分骨折患者行人工肱骨头置换.术前测量健侧大结节最低点至肱骨头最高点的距离;术中尽量复位大小结节,合理控制假体高度及后倾角度,尽量修复损伤肩袖;术后分3阶段有计划康复治疗.结果 15例均获随访,时间9个月～6年5个月.11例完全不痛,2例肩峰后下方有压痛,1例肩关节上举运动痛,1例有轻度肩关节不稳.Neer评分:优7例,良6例,可2例.结论 对于老年肱骨近端严重三、四部分骨折、特别是有头部粉碎骨折患者行人工肱骨头置换术,只要严格把握手术适应证,遵循肱骨头置换过程中的关键技术方法,有计划进行术后康复训练,可快速恢复肩关节良好的活动功能.     

肱骨近端"头帽型"骨折的解剖学特点及诊疗方案研究

目的探索适合肱骨近端特殊类型的"头帽型"骨折的诊疗方案，降低术后并发症的发生率。 方法根据骨折的影像学分型、解剖学特点及术后并发症的发生率，结合北京大学人民医院创伤骨科2016年1月至2017年12月诊治的肱骨近端"头帽型"骨折患者18例诊疗结果，研究肱骨近端"头帽型"骨折的诊疗特殊性。 结果符合肱骨近端"头帽型"骨折分型的18例中9例采取切开复位钢板内固定手术治疗，有2例（22%）出现了不同程度的肱骨头吸收、肱骨头骨块厚度变薄和预后肩关节活动功能差；而采取人工关节置换术的9例未出现预后肩关节活动受限等并发症。 结论"头帽型"骨折术后发生肱骨头坏死、畸形愈合等风险高，应高度重视该骨折类型固定的特殊性。     

A Shearing Osteochondral Fracture of the Humeral Head Following an Anterior Shoulder Dislocation in a Child

A dislocation of the shoulder joint is rare in children with an open physis. The fractures associated with an anterior dislocation generally reported in the literature have been Hill-Sachs lesions, avulsions of the greater tuberosity and glenoid fractures. We present a case of a previously unreported shearing osteochondral fracture, which is distinct from a classic Hill-Sachs lesion of the humeral head, in 12-year-old boy. The patient suffered a traumatic anterior shoulder dislocation with a spontaneous reduction along with this associated fracture. The fracture subsequently healed with no further evidence of persistent instability.     

When is it safe to reduce fracture dislocation of shoulder under sedation? Proposed treatment algorithm

Introduction

Shoulder dislocations are common. It is known that incongruent shoulder should be promptly reduced. However, when associated with fracture of the proximal humerus, there is a clinical dilemma if reduction under sedation is a safe option. We wanted to establish when it is safe to attempt reduction of a shoulder fracture dislocation under sedation in emergency room.

Methods

This is a retrospective cohort study assessing consecutive patients presenting with a dislocation of a gleno-humeral joint with an associated fracture of the humerus between 2007 and 2015. The radiographs and patients’ records were examined. The number of fragments according to Neer’s criteria and size of fragments were recorded.

Results

We identified 102 patients who presented with 104 cases of fracture dislocation of shoulder joint. 10 of the dislocations were posterior, remainder were anterior. All posterior dislocations were reduced under general anaesthesia. Sixty-two anterior fracture dislocations had attempted reduction under sedation in emergency department. Eight of those were unsuccessful, and patient required general anaesthetic for further management. In five of those cases, significant displacement of humeral head in relation to the shaft after attempted reduction.

Conclusion

We propose pragmatic approach to the initial treatment of fracture dislocations of shoulder. In type I injury, where there is an anterior dislocation with greater tuberosity fracture, one should attempt a reduction under sedation; 94% of attempted reductions under sedation were successful and no fracture propagation occurred. In case of a type II injury, when the fracture is involving a surgical neck of the humerus with or without greater tuberosities fracture, our experience suggests that no attempt of reduction is undertaken under sedation and patient has general anaesthetic. Posterior dislocation with any fracture remains an unsolved problem, but in our series no attempt of reduction under sedation was made.

     

Surgical treatment of sequelae of fractures of the proximal third of the humerus. The role of osteotomies

Between 1996 and 2003 a total of 19 humeral head osteotomies were performed to treat post-traumatic malunion of the proximal humerus. Mean age was 46 years, ranging from 17 to 71 years. The period of time between traumas and surgeries ranged from 6 to 22 months. Osteotomy procedure was as follows: one after two-part fracture of the greater tuberosity, three after two-part fracture of the surgical neck, five after three-part fracture of the greater tuberosity, eight after four-part fracture, two after complex head splitting fracture, one after two-part fracture with anterior dislocation. Three different types of osteotomies were performed: osteotomy of the humeral neck for varus deformity, isolated osteotomy of the greater tuberosity, and a new osteotomy technique (two-plane and three-plane osteotomy) for three- and four-fragment fracture sequelae. At the time of follow-up evaluation, all 19 patients were questioned regarding pain and function. Excellent results in 14 patients and satisfactory results in 5 were obtained. None of the patients required revision surgery. Findings were recorded using the Constant rating scale. All patients had had significant pain relief after shoulder osteotomy. Range of motion was increased in all patients treated by osteotomy. The success of osteotomy in these cases was based on: patient selection, extensive preoperative evaluation, surgical technique and postoperative rehabilitation.     

肱骨近端骨折肱骨头置换假体高度的控制

目的:评估利用大结节骨折片复位的方法,确定肱骨近端骨折肱骨头置换假体高度的临床疗效。方法:回顾性研究2015年1月至2019年12月收治并获得随访的肱骨近端骨折患者,符合肱骨头置换指征19例,男7例,女12例;左侧8例,右侧11例;年龄58~84(71.5±5.8)岁;受伤至手术时间3~18(7.9±4.3) d。根据Neer分型,3部分骨折伴脱位2例,4部分骨折17例,其中伴肱骨头脱位6例,肱骨头劈裂2例。19例采用组配式肱骨头假体,在手术过程中,试复位肱骨大结节骨折块,确定肱骨大结节顶点到肱骨标记点的距离,以此距离作为假体高度的标准。术后1年采用Constant-Murley评分,美国加州大学洛杉矶分校(University of California,Los Angeles,UCLA)肩关节评分评价肩关节功能状况及患者满意度。结果:19例均获随访,时间12~58(31.9±14.2)个月。测量手术后上臂长度26~32 cm,双侧比较误差<0.5 cm。术后3个月肩关节正侧位X线片示骨折均愈合。术后1年Constant-Murley评分(80.8±8.9)分,UCLA评分(27.9±4.8)分。术后1年患者满意度89.5%(17/19)。结论:肱骨近端骨折肱骨头假体置换手术过程中,试复位肱骨大结节骨折块,确定肱骨大结节顶点到肱骨标记点的距离,以此距离确定假体高度,方法简单准确,临床效果良好。     

Rare, bilateral posterior shoulder dislocation. A case report

Posterior shoulder dislocation is a very rare injury, accounting for only 1-2% of all shoulder dislocations. It is very often misdiagnosed because its clinical symptoms are not characteristic and the X-ray pictures are often misinterpreted. In many cases this means delayed treatment and impaired shoulder function. The most common cause of posterior shoulder dislocation is an epileptic seizure. In approximately 50% of all cases a ventral impression fracture of the humeral head is diagnosed. This is known as the "reverse Hill-Sachs lesion". About 10% of all posterior shoulder dislocations are associated with fracture of the lesser tuberosity of the humerus. In this paper a case of bilateral posterior shoulder dislocation with bilateral fracture of the lesser tuberosity of the humerus is described. The luxations were caused by an epileptic seizure following chronic alcohol abuse. Following early commencement of an exercise programme excellent results were obtained, and no redislocations occurred.     

Missed posterior shoulder dislocation with malunited proximal humerus fracture

Posterior dislocation of the shoulder may be missed or neglected at initial presentation especially in developing countries.We present a case of 40-year-old Indian man who had 3-month missed posterior dislocation of the right shoulder along with malunited fracture of the anatomical neck of the humerus.Open reduction and stabilization with modified McLaughlin procedure was performed.Rotational osteotomy of proximal humerus had to be performed as supplementary procedure to keep the humeral head stable in glenoid cavity during functional range of movements.The patient had excellent result of the shoulder at 3 years follow-up.     

人工肱骨头置换术后并发症的相关研究:双目三维测量装置的应用

目的通过制备肱骨近端四部分骨折模型及成熟的加载测量装置，以进行有关肱骨近端人工关节置换的相关生物力学研究。方法采集新鲜成人肩关节尸体标本8对16具，应用截骨的方法制成肱骨近端四部分骨折模型，对其进行人工假体重建，并分为解剖重建组和重叠重建组。设计并制作模型加载装置及光学测量装置。测定在肩关节处于不同运动角度时，大结节相对于肱骨干骺端的位移情况。检验整套装置是否具有稳定的可重复性。结果成功制成肱骨近端四部分骨折模型。各个标本在肩关节运动至各个不同角度时，多次重复相同的肩关节运动，其大结节的位移值基本一致或相差很小。检测中发现大结节在肩关节活动过程中有明显移位，在个别标本中甚至超过20mm。结论本试验所设计的加载及测量方式可成功模拟肱骨头置换术后肩关节在进行被动活动的过程中，大结节所受的生物力学作用及在此作用下大结节的位移情况。现有的针对人工肱骨头置换的大结节固定方法，在术后即刻的关节被动活动中，仍可导致大结节相对骨干的明显位移。