改良Mclaughlin手术治疗肩关节后脱位伴反Hill-Sachs损伤的疗效观察  

作　　者：邢时通[1] 闵继康[1] 吴浩波[2] 冯刚[2] 张占丰[1] 

机构地区：[1]浙江省湖州市第一人民医院,313000 [2]浙江大学医学院附属第二医院,310051

出　　处：《浙江临床医学》2019年第7期935-937,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨改良Mclaughlin手术治疗肩关节后脱位伴反Hill-Sachs损伤的临床效果及其影响因素。方法回顾性分析2011年7月至2018年5月21例肩关节后脱位合并反Hill-Sachs损伤患者资料。男15例,女6例;平均年龄41.5岁(33-56岁);左肩12例,右肩9例;新鲜损伤(受伤至手术时间<3周)14例,陈旧损伤(受伤至手术时间≥3周)7例;受伤至手术时间4.61d(平均17.1d)。术后4周、12周、1年及以后每年进行随访,对比分析新鲜损伤与陈旧损伤患者肩关节活动范围、加州大学肩关节功能评分(UCLA评分)和Constant-Murley肩关节评分;影像学检查小结节骨块愈合情况。结果21例患者术后均获随访,平均随访时间22.8个月(10.33个月)。肩关节UCLA评分(29.5±3.4)分,Constant-Murley肩关节评分(75.5±6.7)分。新鲜损伤与陈旧损伤的UCLA评分[(30.9±2.2)vs.(26.7±3.9)]差异有统计学意义(t=2.694,P=0.031),Constant-Murley评分中肩关节内旋[(8.3±1.1)vs.(6.9±1.1)]差异有统计学意义(t=2.887,P=0.009).影像学检查21例肩关节均获得骨性愈合,愈合时间(5.3±1.1)个月,在随访时限内无一例出现肱骨头坏死或盂肱关节骨性关节炎,同时所有患者均未出现再次肩关节脱位。结论肩关节后脱位合并反HiU-Sachs损伤是一种罕见的创伤,采用改良的McLaughlin手术对其进行治疗效果确切,新鲜损伤的治疗效果优于陈旧损伤。Objectve To present outcomes of modified Mclaughlin procedure for reverse Hill-Sachs lesion in posterior shoulder dislocation. Method With a diagnosis of reverse Hill-Sachs lesion in posterior shoulder dislocation, 21 shoulders ( 15 male, 6 female, age range: 33~56 years, mean age: 41.5 ± 7.1 years, 12 left shoulders, 9 right shoulders, 14 acute injuries, 7 chronic injuries, mean time from injury to operation: 17.1 ± 15.7 days ) were included from July 2011 to May 2018 from 2 medical inst让utions.They were evaluated with range of motion of shoulder, University of California-Los Angeles Shoulder Scale ( UCLA Scale ),Constant-Murley score, and radiology in follow-up. Results The mean follow-up period was 22.8 ± 5.8 months ( range 10~33 months). The mean UCLA Scale was 29.5 ± 3.4. The mean Constant-Murley score was 29.5 ± 3.4. The differences were significant between acute injuries and chronic injuries in UCLA Scale (30.9 ± 2.2, 26.7 ± 3.9, t=2.694, P=0.031 ). The differences were significant between acute injuries and chronic injuries in internal rotation of Constant-Murley score ( 8.3 ±1.1, 6.9 ± 1.1, t=2.887, P=0.009 ). All the transfer graft were healed well without humeral head necrosis or recurrent dislocation. Conclusion The modified Mclaughlin procedure shows satisfying result for reverse Hill-Sachs lesion in posterior shoulder dislocation, while the outcomes of acute injuries are superior to those of chronic injuries.

关 键 词：肩关节脱位 肱骨骨折 骨折固定术 内 

分 类 号：R684.7[医药卫生—骨科学]