【摘要】 <正>急性创伤性肩关节后脱位的发生率较低,其发生率仅为肩关节前脱位的1/22左右^[1],约占肩关节脱位的2%～5%^[2]。但初诊漏诊率却高达73.2%,平均延误诊断时间为伤后5.5个月左右^[3],最长可达伤后25年^[4]。急性创伤性肩关节后脱位好发于中青年^[5],一旦漏诊后果严重。肱骨头和肩胛盂间处于互相啮合后脱位状态,可导致肱骨头关节软骨面出现继发性大面积缺失和肩胛盂磨损,在伤后早期就可出现严重盂肱关更多还原

【Abstract】 Posterior shoulder dislocation has low incidence and high missed diagnosis rate. History of seizures, electric shock or high energy injury should be highly valued as the high risks. Detailed shoulder joint examination combined with standardized multi-aspect or shoulder CT is the only way to avoid missed diagnosis. Early diagnosis and timely reduction are the key to the treatment of posterior dislocation of the shoulder joint. The goal of treatment is to meet the patient’s daily functional requirements while balancing shoulder stability and flexibility.Individualized treatment plan should be designed based on a comprehensive evaluation of many factors. Even though the general principle of recognizing and treating the humeral head bone defects in patients with posterior shoulder dislocation is widely accepted, a consensus measurement to calculate Reverse Hill-Sachs bone loss has not been established yet. Therapy options include non-operative treatment, non-anatomical techniques(McLaughlin or its modifications) for reverse Hill-Sachs lesions with impairment of the articular surface between 20% and 50%, and the implantation of a shoulder prosthesis. Posterior capsular injuries most often heal without surgical repair, but it can be considered in cases of refractory instability. Open surgery is still a standard procedure in most cases with bone loss. The transition from open to arthroscopic surgery has been described but this technique is only successful in some experienced hands with limited indications. The incidence of the rotator cuff tear in association with a posterior glenohumeral dislocation may be underestimated. If there is failed closed reduction of a posterior dislocation, a trapped long head of biceps tendon or the rotator cuff lodged within the glenohumeral joint should also be considered. The repair of the concomitant traumatic massive cuff tears always drives excellent pain relief and function recovery.更多还原