目的 探讨合并Hill-Sack损伤的难复性肩关节前脱位对抗牵引法整复的技巧、机制和临床疗效。方法 回顾性分析北京市石景山医院2017-01至2020-12收治的26例合并Hill-Sack损伤的难复性喙突下肩关节脱位的患者,采用肩关节腔注射麻醉下对抗牵引法进行整复,总结复位前后疼痛视觉模拟评分(VAS)、复位成功率、复位时长、复位过程中的面部表情评分(FRS)和相关并发症。结果 本组患者术前VAS评分为(7.23±2.19)分,术中FRS评分为(2.04±0.37)分,复位后即刻VAS评分为(2.17±0.93)分,复位时长为(6.35±2.31)min,复位成功率为96.15％,整复过程中无血管、神经损伤和医源性骨折发生。术后6周Constant评分总分为(91.71±6.28)分,所有患者在此期间均未发生再次脱位。结论 在肩关节腔注射麻醉下,采用对抗牵引法整复合并Hill-Sack损伤的喙突下肩关节脱位的成功率高,并发症少,整体复位过程患者满意度高。

Objective To investigate the reduction technique and clinical effect of counter-traction against irreducible anterior shoulder dislocation combined with Hill-Sachs lesion. Methods The clinical data on twenty-six patients with irreducible sub-coracoid shoulder dislocation combined with Hill-Sack lesion who had received the counter-traction reduction in our hospital between January 2017 and December 2020 was retrospectively reviewed. The visual analogue scale (VAS) score, reduction success rate, duration of reduction, the Faces Rating Scale (FRS) score during reduction, and related complications were recorded. Results In these patients, the mean VAS score was 7.23±2.19 preoperatively, the mean FRS score was (2.04±0.37) intraoperatively, the mean VAS score was 7.23±2.19 postoperatively, and the mean duration of reduction was (6.35±2.31) minutes. The reduction success rate was 96.15%. No vascular or nerve injury or iatrogenic fracture occurred during the reduction. The average constant score at 6 weeks after reduction was 91.71±6.28. No dislocation occurred during the follow-up. Conclusions Under intra-articular anesthesia of the shoulder, the success rate of counter-traction for reduction of sub-coracoid shoulder dislocation with Hill-Sack lesion is high with fewer complications, and most patients are satisfied with the outcome.