摘要
目的探讨肩胛骨骨折(scapularfracture,SF)的分类及手术治疗.方法回顾分析自1996年1月～2001年1月收治的经手术治疗的16例SF的临床资料.其中行前后位X线检查者16例,侧位及腋窝位X线检查者5例,螺旋CT三维重建检查者12例.根据Hardegger的分型方法,体部骨折9处、肩胛颈骨折7处、盂缘骨折2处、盂窝骨折1处、肩胛冈骨折5处、肩峰骨折3处、喙突骨折2处.其中混合型骨折11例(68.8%),伴有合并损伤者14例(87.5%).通过前方入路、后方入路、后上入路及前后联合入路分别对不同类型的SF使用重建钢板或拉力螺钉等固定.结果 16例患者全部获得随访,随访时间12～60个月,平均18.6个月.根据Rowe的疗效评价标准,优11例,良2例,可1例,差2例,优良率为81%.术后主要并发症包括创伤性关节炎2例,异位骨化1例,肩关节不稳定1例.结论 (1)SF多由高能暴力所致,常伴有合并损伤.三维CT重建有助于明确骨折类型和选择治疗方法;(2)盂窝骨折台阶样移位在3～5 mm以上、盂缘骨折合并肱骨头半脱位、某些体部爆裂骨折、肩胛颈骨折失稳及浮肩损伤等应行手术治疗;(3)手术治疗是一种安全有效的方法,严重SF至少需随访1年,才能确定功能预后.
Objective To explore the early diagnosis and surgical treatment of scapular fractures. Methods Sixteen cases with scapular fractures received operation that had been admitted to our hospital from January 1996 to January 2001 were retrospectively analyzed. AP views of X-ray, two-dimensional CT scannings and three-dimensional CT reconstructions were used to confirm the injuries. According to Hardegger's classification for scapular fractures, There were 9 fractures of the scapular body, 7 fractures of the scapular neck, 2 fractures of the glenoid rim, 1 fracture of the glenoid fossa, 5 fractures of the scapular spine, 3 fractures of the acromion and 2 fractures of the coracoid process. Of the 16 patients, 11(68.8%) cases had complex fractures of the scapula, and 14 cases (87.5%) had associated injuries. On the basis of the fracture patterns, anterior, posterior, posterosuperior approach,and anterior combined posterior approach were performed with plates or(and) lag screws for surgical reconstruction. Results All patients were followed up with an average of 18.6 months. According to Rowes evaluation, 11 cases showed excellent results, 2 good, 1 fair, and 2 poor. The glenohumeral posttraumatic arthritis of the series was found in 2 cases, heterotopic ossification in 1 case, and shoulder joint instability in 1 case. Conclusion 1) Scapular fractures are caused by high-energy violence with a high incidence of serious associated injury. Computerized tomography scanning with three-dimensional imaging is helpful to determine the fracture pattern and degree of displacement; 2) Intra-articular fracture of the glenoid fossa with more than 3 to 5 mm of step-off displacement, the glenoid rim fracture combined with humeral head subluxation, grossly displaced fracture of the scapular neck, some bursting fractures of the body, and floating shoulder injuries should be operated; 3) Open reduction and internal fixation is an useful and safe technique for the treatment of specific displaced fractures of the scapula. It needs at least 12 months to determine the final functional result.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第2期100-104,共5页
Chinese Journal of Orthopaedics
关键词
肩胛骨骨折
分类
手术
术后并发症
骨折固定术
Scapula
Shoulder fracture
Diagnosis
Freature fixation, internal
Treatment outcome
