创伤性肩关节后脱位的诊断与治疗

目的探讨创伤性肩关节后脱位的诊断方法和治疗效果。方法对2005年5月～2010年10月本院诊治的5例肩关节后脱位进行回顾性研究。5例患者中,本院漏诊1例酒精戒断症状发作后肩关节后脱位,本院及时正确诊断2例,分别为癫痫发作和车祸外伤后肩关节后脱位,外院漏诊2例,分别为车祸和坠落伤。早期正确诊断的2例中,1例行早期闭合复位,1例行切开复位;3例漏诊致陈旧性脱位患者,其中2例行改良McLaughlin手术切开治疗,1例放弃复位治疗。结果随访2～4年（平均32个月）,早期闭合复位的1例UCLA肩关节评分33分,早期正确诊断并行切开复位的1例UCLA肩关节评分31分,漏诊的陈旧性肩关节后脱位中2例手术治疗的UCLA肩关节评分分别为27分和30分,未予复位者UCLA肩关节评分22分,但随访时对结果表示满意。结论临床上对肩关节后脱位缺乏足够认识是造成漏诊的主要原因,早期诊断、早期复位是获得良好肩关节功能的重要保证。

Diagnosis and treatment of traumatic posterior shoulder dislocation

Objective To discuss the diagnosis and treatment of traumatic posterior shoulder dislocation. Methods Five traumatic posterior shoulder dislocation cases admitted to our department from May 2005 to October 2010 were analyzed retrospectively. Among the five cases, two cases were diagnosed as acute traumatic posterior shoulder dislocation after epileptic seizure and traffic accident respectively. One of the two diagnosed cases was treated by close reduction and the other was treated by open reduction. The third case with an onset after alcohol withdrawal was misdiagnosed. The other two patients were also misdiagnosed in ER of other hospitals and diagnosed correctly in our department. Among these three cases, two were treated by open reduction with modified McLaughlin procedure, and the other one gave up. Results Five cases were followed-up from two to four years with an average time of 32 months. Evaluated by the UCLA scoring system, the case with early close reduction scored 33 at the end, the case of early open reduction scored 31, and the other two cases with modified McLaughlin procedure scored 27 and 30. The one without reduction scored only 22, but he was satisfied with the result. Conclusion Lack of recognization is the most important cause of missed diagnosis of traumatic posterior shoulder disolocation. Excellent or good shoulder function depends on early diagnosis and treatment.