骨科英文书籍精读（68）｜肩关节前脱位并发症（1）
Complications
EARLY
Rotator cuff tear
This commonly accompanies anterior dislocation, particularly in older people. The patient may have difficulty abducting the arm after reduction; palpable contraction of the deltoid muscle excludes an axillary nerve palsy. Most do not require surgical attention, but young active individuals with large tears will benefit from early repair.
Nerve injury
The axillary nerve is most commonly injured; the patient is unable to contract the deltoid muscle and there may be a small patch of anaesthesia over the muscle. The inability to abduct must be distinguished from a rotator cuff tear. The nerve lesion is usually a neuropraxia which recovers spontaneously after a few weeks; if it does not, then surgery should be considered as the results of repair are less satisfactory if the delay is more than a few months.
Occasionally the radial nerve, musculocutaneous nerve, median nerve or ulnar nerve can be injured. Rarely there is a complete infra-clavicular brachial plexus palsy. This is somewhat alarming, but fortunately it usually recovers with time.
Vascular injury
The axillary artery may be damaged, particularly in old patients with fragile vessels. This can occur either at the time of injury or during overzealous reduction. The limb should always be examined for signs of ischaemia both before and after reduction.
Fracture-dislocation
If there is an associated fracture of the proximal humerus, open reduction and internal fixation may be necessary. The greater tuberosity may be sheared off during dislocation. It usually falls into place during reduction, and no special treatment is then required. If it remains displaced, surgical reattachment is recommended to avoid later subacromial impingement.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
palpable contraction of the deltoid muscle excludes an axillary nerve palsy.可触及的三角肌收缩排除了腋窝神经麻痹。
deltoid /'dɛltɔɪd/n. 三角肌adj. 三角形的
neuropraxia神经失用症
musculocutaneous/,mʌskju'lekətəniəs/adj. [解剖] 肌皮的
infra-clavicular brachial plexus palsy锁骨下臂丛神经麻痹
infra-clavicular /,infrəklə'vikjulə/adj. 锁骨下的
alarming /əˈlɑːrmɪŋ/adj. 令人担忧的；使人惊恐的
overzealous /ˌoʊvərˈzeləs/adj. 过分热心的
ischaemia /is'ki:miə/n. 局部贫血
tuberosity/,tʊbə'rɑsɪti; ,tjʊbə'rɑsɪti/n. 结节
surgical reattachment手术复位
subacromial impingement.肩峰下撞击 /im'pindʒmənt/n. 冲击；影响；侵犯。
百度翻译：
早期并发症
肩袖撕裂
这通常伴有前脱位，尤其是老年人。患者在复位后可能难以外展手臂；可触摸到的三角肌收缩排除了腋神经麻痹。大多数不需要手术治疗，但年轻活跃的大眼泪个体将受益于早期修复。
神经损伤
腋神经是最常见的损伤；病人不能收缩三角肌，肌肉上可能有一小片麻醉。不能外展必须与肩袖撕裂区分开来。神经损伤通常是神经衰弱，几周后自然恢复；如果没有，则应考虑手术，因为如果延迟超过几个月，修复效果就不太令人满意。
桡神经、肌皮神经、正中神经或尺神经偶尔会受到损伤。很少有完全性锁骨下臂丛神经麻痹。这有点令人担忧，但幸运的是，它通常会随着时间的推移而恢复。
血管损伤
腋动脉可能受损，尤其是老年血管脆弱的患者。这可能发生在受伤时，也可能发生在过度的复位过程中。在复位前和复位后，应始终检查肢体是否有缺血迹象。
骨折脱位
如果肱骨近端合并骨折，可能需要切开复位和内固定。脱位时大结节可能被切除。它通常在还原过程中到位，然后不需要特殊处理。如果仍然移位，建议手术复位，以避免后期肩峰下撞击。