改良Mclaughlin手术联合肱骨近端锁定钢板治疗肩关节后脱位伴骨折

目的:探讨改良的Mclaughlin手术联合锁定钢板治疗肱骨头损伤面积40%的肩关节后脱位伴骨折患者的临床疗效。方法:自2012年7月至2017年6月收治肩关节后脱位伴骨折患者7例,其中男5例,女2例;年龄37～53岁;合并肱骨头劈裂骨折3例,肱骨外科颈骨折4例。手术方法采用改良的Mclaughlin手术联合锁定钢板固定。观察术后肩关节活动范围,采用加州大学肩关节功能评分(University of California-Los Angeles Shoulder Scale,UCLA)进行临床疗效评价。结果:7例患者获得随访,时间10～33个月。末次随访时肩关节前屈上举130°～170°,外旋45°～75°,外展105°～150°,内旋均在L_3椎体到臀水平之间; UCLA评分29～34分,其中优1例,良6例。结论:改良的Mclaughlin手术联合肱骨近端锁定钢板对肩关节后脱位伴骨折这一罕见损伤的治疗,可有效保证术后肩关节稳定性,但对术后肩关节内旋存在一定程度的影响。

Modified Mclaughlin procedure combined with locking plate for posterior shoulder dislocation with fracture

Objective: To study clinical effects of modified Mclaughlin procedure combined with locking plate for posterior shoulder dislocation with proximal humeral fracture which area of femoral head injury less than 40%.Methods: From July 2012 to June 2017,7 patients with posterior shoulder dislocation were treated,including 5 males and 2 females;aged from 37 to 53 years old. Three patients combined with split of humerus head and 4 patients combined with humerus surgical neck fracture. All patients treated with modified Mclaughlin procedure combined with locking plate. Motion of shoulder joint after operation was observed,postoperative UCLA score was used to evaluate clinical effects.Results: Seven patients were followed up from 10 to 33 months. The motion of anteflexion and up-lift ranged from 130° to 170°,the motion of extorsion ranged from 45° to 75°,the motion of abduction ranged fron 105° to 150°,and the internal rotation was between L₃ to buttock. UCLA score ranged from 29 to 34;and 1 patient reached excellent,and 6 patients good.Conclusion: The modified Mclaughlin procedure combined with locking plate showed satisfying result for posterior shoulder dislocation combined with fractures. However,the internal rotation of shoulder could be compromised.