- 期刊
肩盂肱骨關節脫臼合併腋神經損傷及肩旋轉帶破裂：病例報告暨文獻回顧
Axillary Nerve Injury and Rotator Cuff Rupture after Glenohumeral Joint Dislocation: A Case Report and Literature Review
摘要
肩盂肱骨關節脫臼常見於外傷性肩關節損傷，追蹤病人首次發生肩盂肱骨關節脫臼後的恢復情形發現：年輕的病人，以肩盂肱骨關節不穩定居多，而年齡大的病人，常會合併肩盂肱骨關節周邊組織的受傷，如肩旋轉帶破裂、周邊神經損傷、肱骨近端骨折以及肱動脈受傷等。 本文報告一位73歲病人，不慎跌倒導致左肩盂肱骨關節脫臼，病人經徒手復位後，發現左肩盂肱骨關節無法往前屈曲、往外伸展及往外旋轉，往後仲展的力量變差，而往內旋轉及內收的功能正常，另外病人肘關節的功能也正常。病人所有的活動都不會產生疼痛，也沒有出現疼痛弧。病人的臨床身體檢查，表現的是一種無痛的乏力。經安排磁振造影檢查，發現病人肩旋轉帶破裂，部位包含岡上肌與岡下肌肌腱完全斷裂；肌電圖與神經傳導檢查，發現病人的腋神經損傷合併三角肌與小圓肌癱瘓。 肩盂肱骨關節脫臼同時合併腋神經損傷與肩旋轉帶破裂的發生，在文獻上也曾提出。一般文獻上，對於肩盂肱骨關節脫臼後肩旋轉帶破裂的治療，愈早手術效果愈好，但對於肩盂肱骨關節脫臼後，腋神經損傷病人的恢復情形與預後，則未有定論。希望藉此一病例討論與文獻回顧，能幫助了解脫臼後的病人可能出現的併發症，提供臨床同仁處理相關病人的參考。
並列摘要
Dislocation of the glenohumeral joint is a frequent disorder that occurs among traumatic injuries of the shoulder. There are differences in the dislocation between young and older patients. Recurrent instability is more common to follow traumatic anterior dislocation of the glenohumeral joint in young patients than older patients. Neurologic complications and associated soft tissue injuries after a glenohumeral dislocation occur more frequently in patients around 40 years of age and older. A 73-year-old patient suffered from dislocation of left glenohumeral joint after falling down. Paralysis of left shoulder muscle was found after the close reduction. Physical examinations disclosed loss of active range of motion of left shoulder in the position of anterior flexion, abduction and external rotation. Decreased muscle power of left shoulder in extension was also found. The active range of motion of left shoulder in internal rotation and adduction was normal. The active range of motion of left shoulder girdle and elbow was also normal. There was neither pain nor painful arc during motion. Painless weakness of left shoulder was noted in anterior flexion, abduction and external rotation. Magnetic resonance imaging of left shoulder disclosed massive tears of the rotator cuff (the supraspinatus and the infraspinatus tendons). Nerve conduction velocity and electromyogram studies revealed axillary nerve injury, which resulted in complete paralysis of deltoid and teres minor. Rotator cuff tears together with axillary nerve injury after dislocation of the glenohuermal joint have been documented in the medical literatures. Early surgical intervention seems to have a good outcome to treat rotator cuff tears, even a variable reported prognosis for axillary nerve recovery. This case report aims at reminding the clinician how to manage complications after dislocation of the glenohumeral joint. In the meanwhile, the occurrence of rotator cuff tears with axillary nerve injury after dislocation of the glenohumeral joint was reviewed.
延伸閱讀
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