観血的整復固定術を行った肩関節後方脱臼を伴う4-part骨折の1例

Posterior Dislocation with 4-part Proximal Humeral Fracture. Case Report

　肩関節後方脱臼骨折は稀であり，診断，整復も困難で観血的治療を要することが多い．今回われわれは観血的に治療した1例を経験したので報告する．症例は45歳の男性で，自転車乗車中に転倒し受傷した．単純X線，CTで左肩関節後方脱臼を伴う4-part骨折と診断し，受傷後6日目に全身麻酔下に徒手整復したが整復不能だった．そのため観血的に脱臼整復を行い，その後locking plateによる固定を行った．早期リハビリテーションにより受傷後7カ月の時点で可動域，骨癒合とも良好であった．

　Posterior fracture-dislocation of the shoulder is rare and difficult to diagnose, and open reduction is necessary.　We report a case that was treated surgically.　A 45-year-old man who fell while riding his bicycle was seen on the day of the accident.　A posterior 4-part fracture and dislocation of his left shoulder was diagnosed based on the X-ray and computed tomography findings.　Manual reduction of the fractures' dislocation was impossible, under general anesthesia, 6 days after the injury.　Open reduction, however, was successful, and fixation was achieved with a locking plate.　After early rehabilitaion the joint has good mobility, and there is bone union with no deformity at seven months post injury.