探讨肩关节后脱位合并肱骨近端骨折（posterior shoulder dislocation combined with proximal humerus fractures，PSD-PHF）的诊治方法。

回顾性分析自2020年4月至2023年12月本院诊治的6例骨折Neer分型为Ⅵ型的PSD-PHF患者，采用扩大的胸大肌三角肌间沟入路，暴露后脱位肱骨头及关节囊，松解嵌顿的肱二长头肌腱或肩袖，直视下撬拨复位肱骨头，依次复位各骨折块，先锁定接骨板固定，必要时可联合空心螺钉或捆绑线缆加强固定。当合并肱骨头前缘缺失面积达25%~50%的反Hill-sachs损伤时对肱骨头下骨缺损处植入人工骨给予支撑，最后使用缝线锚钉依次修复撕裂的肩胛下肌、冈上肌腱。比较术前与术后末次随访时的疼痛视觉模拟评分（visual analogue scale，VAS）、美国加州大学肩关节功能评分系统（the University of California - Los Angeles，UCLA）评分及肩关节活动度。

本组6例PSD-PHF患者手术均顺利完成，手术时间50~80 min，平均（65.00±6.42）min；住院时间8~29 d，平均（11.20±1.59）d。所有患者均获得12个月以上随访，随访时间12~20个月，平均（14.30±1.67）个月，6例骨折均获得骨性愈合，平均愈合时间为（5.04±0.62）个月，无内固定松动、脱出。末次随访，患者VAS评分为（1.00±0.21）分，低于术前（8.00±1.30）分（P<0.001）；UCLA评分为（32.53±1.04）分，高于术前（9.08±1.52）分（P< 0.001），其中优4例、良1例、差1例，优良率为83.33%（5/6）；肩关节活动度：前屈（138.85± 18.67）°、外展（128.69±10.57）°、外旋（48.61±2.28）°，均大于术前（60.14±7.21）°、（40.87± 4.26）°、[-（29.85± 3.18）]°（P<0.001）。

Neer Ⅵ型PSD-PHF患者在临床中较为罕见，早期诊断、早期手术可以促进患者骨折愈合、减轻疼痛、改善肩关节功能和恢复肩关节活动度。

Posterior shoulder dislocation (PSD) is a rare injury with an incidence rate of approximately 1.10 per 100,000, accounting for only 2% to 5% of all types of shoulder dislocations. Coupled with its lack of typical symptoms and imaging manifestations, the rate of missed diagnosis at the initial diagnosis is as high as 60% to 79%. Therefore, it is rare in clinical practice and highly challenging in clinical diagnosis and treatment. PSD is often caused by direct or indirect high-energy violence such as car accidents, epileptic seizures, and electric shocks. PSD is frequently accompanied by proximal humeral fractures (PHF). PHF can be classified into six types according to the Neer classification, and the higher the number, the more severe the injury. Among them, Neer typeⅥ is usually accompanied by humeral head fragmentation, bone defect, and severe rotator cuff injury. If PSD combined with Neer typeⅥ PHF is not diagnosed and treated in time, it can easily cause shoulder joint pain, stiffness, shoulder deformity, limited movement, shoulder instability, etc. Over time, it may lead to humeral head necrosis due to a blood circulation disorder. Currently, for patients with Neer typeⅥ PSD-PHF, open reduction and internal fixation treatment should be performed. The goal is to achieve anatomical reduction, stable fixation, and early functional exercise. Although clinical reports on patients with simple PHF are not uncommon at present, for patients with the special type of PSD-PHF, such as "fracture - dislocation", due to the small number of cases and the difficulty of intraoperative reduction, there is still a lack of strong evidence-based medical basis for the selection and operation of surgical methods in clinical practice at present.

To explore the diagnosis and treatment methods of posterior shoulder dislocation combined with proximal humerus fractures (PSD-PHF) .

A retrospective analysis was conducted on six patients with PSD-PHF fractures, classified as typeⅥ by Neer, in our hospital from April 2020 to December 2023. The expanded deltoid groove approach of the pectoralis major muscle was adopted. The dislocated humeral head and joint capsule were exposed, the incarcerated biceps brachii tendon or rotator cuff was released, the humeral head was pried and reduced under direct vision, and each fracture fragment was reduced successively. First, lock the bone plate for fixation. If necessary, hollow screws or bundled cables can be used to enhance the fixation. When combined with the anti-Hill-Sachs injury with an anterior edge loss area of the humeral head reaching 25% to 50%, artificial bone is implanted at the bone defect site under the humeral head to provide support. Finally, suture anchors are used to repair the torn subscapularis muscle and supraspinatus tendon in sequence. Compare the visual analogue scale (VAS) for pain before the operation and the University of California- Los Angeles shoulder function scoring system at the last follow-up after the operation. UCLA score and shoulder joint range of motion.

The surgeries of all six patients with PSD-PHF in this group were completed. The operation time ranged from 50 to 80 minutes, with an average of (65.00±6.42) minutes. The hospital stay ranged from 8 to 29 days, with an average of (11.20±1.59) days. All patients were followed up for more than 12 months. The follow-up period ranged from 12 to 20 months, with an average of (14.30±1.67) months. Bony union was achieved in all 6 fractures, with an average healing time of (5.04±0.62) months. There was no loosening or prolapse of internal fixation. At the last follow-up, the VAS score of the patients was (1.00±0.21) points, which was lower than that before the operation [ (8.00±1.30) points] (P<0.001). The UCLA score was (32.53±1.04) points, which was higher than that before the operation (9.08±1.52) points (P<0.001). Among them, there were 4 cases of excellent, 1 case of good, and 1 case of poor, and the excellent and good rates were 83.33% (5/6). Shoulder joint activity: proneness (138.85+ 18.67) °, outreach (128.69-10.57) °, outside screw (48.61 + 2.28) °, were greater than preoperative (60.14+ 7.21) °, (40.87-4.26) °, ° [- (29.85 + 3.18) ] (P< 0.001) .

Patients with Neer typeⅥ PSD-PHF are relatively rare in clinical practice. Early diagnosis and early surgery can promote fracture healing, relieve pain, improve shoulder joint function, and restore shoulder joint range of motion in patients.