Surgical Approaches, Pitfalls and Outcomes of Posterior Fracture Dislocations of the Shoulder—A Critical Review: 肩關節後脫位合併骨折的手術入路,困難與結果之批判性回顧

Posterior fracture dislocation of the shoulder is rare injury. Treatment is challenging especially for a complex type fracture dislocation with delayed presentation or a reverse Hill-Sachs lesion. We reviewed the surgical approaches, the reduction and fixation techniques, management of reverse Hill-Sachs lesion, pitfalls, and outcomes. We also shared our experience in treating a short case series of posterior fracture dislocation of the shoulder. There were no major complications such as wound infection, nerve palsy, non-union or avascular necrosis of the humeral head in our patients. All could cope with the original activities and had satisfactory recoveries of shoulder functions. The anterior deltopectoral approach alone had some limitation especially in the delayed cases and with complex fracture dislocation. The Utility approach was noted to be a versatile approach for the chronic or delayed cases.

中文摘要肩關節後脫位合併骨折為一種罕見的創傷，其中以複合性關節骨折脫位，延遲就醫以及反Hill-Sachs損傷更具挑戰性。本文探討肩關節後脫位合併骨折的不同手術入路方法、復位和內固定術、處理反Hill-Sachs損傷、困難與結果。我們並分享治療肩關節後脫位合併骨折的經驗。在我們的一小案糸列中，沒有嚴重的併發症如傷口感染、神經麻痺、骨折不愈合形成的骨不連和股骨頭缺血性壞死，全部病人癒後皆可以應付原來的活動及得到滿意的肩關節功能之復元。單一肩關節前方胸三角肌間溝入路有一些限制，尤其是在延遲的案例和複合骨折脫位。多用途的手術入路方法，對慢性或延遲的病例較適合。