16例陈旧性肩关节脱位合并肱骨头骨缺损治疗研究.doc

16例陈旧性肩关节脱位合并肱骨头骨缺损治疗研究【摘要】目的：探讨合并肱骨头骨缺损的陈旧性肩关节脱位手术治疗的方法和临床疗效。方法：2001年8月至2010年1月间共手术治疗合并肱骨头骨缺损的陈旧性肩关节脱位16例,均为外伤所致，受伤至确诊时间为8～20周，平均12.1周，其中肩关节前脱位10例，后脱位6例。前脱位患者予以骨缺损处自体骨植骨可吸收螺钉固定，后脱位患者予以Neer改良的McLaughlin手术。前后脱位患者，术后均予以肩关节石膏固定，6周去除石膏固定, 7～8周时进行轻度的摇摆活动，随后逐渐开始肩关节全范围主动功能锻炼。结果:术后随访6～24个月, 平均12.3月，未再复发，植骨全部愈合，肩关节活动度，平均前屈上举115°,外展85°,外旋50°，内旋50°。按照Neer肩关节功能评分标准，良6例，可10例，优良率37.5％。结论：通过缺损区的植骨和相应处理，合并肱骨近端骨缺损的陈旧性肩关节脱位手术治疗可以获得一定的临床效果，部分恢复患者的肩关节功能。 【关键词】肩关节；肩脱位；手术 Treatment of old dislocation of the shoulder joint with segment defects of humeral head. 【Abstract】ObjectiveTo explore the dislocation of the shoulder joint with segment defects of humeral head, and it’s clinical results. Methods A total of 16 cases with dislocation of the shoulder joint associated with segment defects of humeral head were treated with operation from August 2001 to January 2010 in this study. The mean age was 39.5 years. Five cases were anterior dislocation and three cases were posterior dislocation .The mean diagnosis time were 12.1 weeks(8～20 weeks).Autograft was applied for all patients. The arm has kept for 6 weeks. Passive and active ranges of motion were start from 7 to 8 weeks following surgery. Results All patients were follow up with an average 12.3 months (6～24 months).Non-unions and joint instability were reserved. Postoperative motion range of forward elevation was 115°,laternal elevation was 85°,external rotation was 50°,internal rotation was 50°. According Neer shoulder score,6 cases were good(37.5%), 10 cases were fair(62.5%), with the good rate was 37.5%.Conclusion Autograft reconstruction of segment defects of the humeral head associate with chronic dislocation of the shoulder, can make fairy motion and stability of joint. 【Key words】shoulder joint, sislocation , operation 外伤性肩关节脱位在临床上容易漏诊，尤其是肩关节后脱位漏诊率高达60％左右 [1]。在延误诊治的患者中，部分由于外伤导致肱骨近端缺损；部分由于脱位后的反复撞击，导致肱骨近端骨缺损，进而引起肩关节的锁定，即使肩关节闭合复位后也容易再次脱位锁定，严重影响肩关节功能的恢复。作者在2001年8月至2010年1月间共手术治疗合并肱骨头骨缺损的陈旧性肩关节脱位8例,现将其诊治情况报道如下。 1 临床资料