A fracture of the acromion and coracoid processes of scapula is rarely seen in the outpatient clinic,due to the acromion's anatomical position and shape,as well as the strong ligaments and muscles that are attache...A fracture of the acromion and coracoid processes of scapula is rarely seen in the outpatient clinic,due to the acromion's anatomical position and shape,as well as the strong ligaments and muscles that are attached to it.These fractures are caused by either direct or indirect high-energy trauma injuries to the shoulder joint,leading to severe pain and a grossly restricted range of motion.Several acromial classifications were reported,but this type of longitudinal plane fracture of the acromion process in our case is yet to be described in the current literature.We present a rare combination of the coracoid process and unstable acromion bony projection fractures that have not previously been noted for this type of fracture.The closest to this is Kuhn's type III classification.A 51-year-old male presented to our emergency department complaining of the right shoulder pain and difficulty raising his arm following a 2-wheeler accident.The patient was managed by open reduction and internal fixation with 3 cannulated cancellous screws fixation and progressed well with no postoperative complications.He was asymptomatic postoperatively and regained full range of motion after 4 months.展开更多
目的:提出一种肩峰撞击理论以及肩关节Rockwood位片的肩峰形态分型法,探讨该分型法在肩袖损伤诊治中的应用价值。方法:回顾性分析2017年1月至2017年12月因肩峰撞击症或肩袖撕裂行肩关节镜手术的101例患者,其中男34例,女67例;年龄34~76(5...目的:提出一种肩峰撞击理论以及肩关节Rockwood位片的肩峰形态分型法,探讨该分型法在肩袖损伤诊治中的应用价值。方法:回顾性分析2017年1月至2017年12月因肩峰撞击症或肩袖撕裂行肩关节镜手术的101例患者,其中男34例,女67例;年龄34~76(56.31±9.63)岁;病程2~12个月,平均6个月。术前常规拍摄肩关节“三位片”,包括肩关节前后位、Rockwood位以及冈上肌Outlet位。基于肩峰撞击理论以及Rockwood位片将肩峰形态分为3型:Ⅰ型(平坦型)、Ⅱ型(隆起型)、Ⅲ型(撞击型)。两位观察者分别对101例患者的肩关节Rockwood位片按照新分型法、对冈上肌Outlet位片按照传统肩峰形态分型法进行分类统计;冈上肌腱损伤依据关节镜下所见分为无撕裂、部分撕裂、全层撕裂。分别对新分型法、传统分型法进行一致性检验(Kappa值),采用秩和检验比较新肩峰分型法3种肩峰形态的平均肩肱距(acromiohumeral distance,AHD),采用Spearman秩相关性检验以及Gamma法分析比较新肩峰分型法与冈上肌腱撕裂程度之间的相关性。结果:观察者间一致性检验新肩峰分型法优于传统肩峰分型法(0.827vs 0.278),观察者内一致性检验新肩峰分型法均优于传统肩峰分型法(0.921 vs 0.448,0.890 vs 0.539)。新的肩峰形态分型法3种肩峰形态的AHD比较差异无统计学意义(H=2.186,P>0.05)。所有101例患者撞击型肩峰占比最高为45.5%,隆起型肩峰次之36.6%,平坦型肩峰占17.8%。其中撞击型肩峰患者冈上肌腱撕裂发生率为95.7%,新的肩峰分型法与冈上肌腱撕裂程度存在Spearman秩相关(rs=0.719,P<0.001)。结论:肩关节Rockwood位片可以很好的显示肩峰前外侧骨赘,基于Rockwood位片新肩峰分型法可信度高,可重复性良好,其中撞击型肩峰与冈上肌腱撕裂存在密切关联。新分型法相比传统分型以及AHD对肩袖损伤更具诊疗价值。展开更多
文摘A fracture of the acromion and coracoid processes of scapula is rarely seen in the outpatient clinic,due to the acromion's anatomical position and shape,as well as the strong ligaments and muscles that are attached to it.These fractures are caused by either direct or indirect high-energy trauma injuries to the shoulder joint,leading to severe pain and a grossly restricted range of motion.Several acromial classifications were reported,but this type of longitudinal plane fracture of the acromion process in our case is yet to be described in the current literature.We present a rare combination of the coracoid process and unstable acromion bony projection fractures that have not previously been noted for this type of fracture.The closest to this is Kuhn's type III classification.A 51-year-old male presented to our emergency department complaining of the right shoulder pain and difficulty raising his arm following a 2-wheeler accident.The patient was managed by open reduction and internal fixation with 3 cannulated cancellous screws fixation and progressed well with no postoperative complications.He was asymptomatic postoperatively and regained full range of motion after 4 months.
文摘目的:提出一种肩峰撞击理论以及肩关节Rockwood位片的肩峰形态分型法,探讨该分型法在肩袖损伤诊治中的应用价值。方法:回顾性分析2017年1月至2017年12月因肩峰撞击症或肩袖撕裂行肩关节镜手术的101例患者,其中男34例,女67例;年龄34~76(56.31±9.63)岁;病程2~12个月,平均6个月。术前常规拍摄肩关节“三位片”,包括肩关节前后位、Rockwood位以及冈上肌Outlet位。基于肩峰撞击理论以及Rockwood位片将肩峰形态分为3型:Ⅰ型(平坦型)、Ⅱ型(隆起型)、Ⅲ型(撞击型)。两位观察者分别对101例患者的肩关节Rockwood位片按照新分型法、对冈上肌Outlet位片按照传统肩峰形态分型法进行分类统计;冈上肌腱损伤依据关节镜下所见分为无撕裂、部分撕裂、全层撕裂。分别对新分型法、传统分型法进行一致性检验(Kappa值),采用秩和检验比较新肩峰分型法3种肩峰形态的平均肩肱距(acromiohumeral distance,AHD),采用Spearman秩相关性检验以及Gamma法分析比较新肩峰分型法与冈上肌腱撕裂程度之间的相关性。结果:观察者间一致性检验新肩峰分型法优于传统肩峰分型法(0.827vs 0.278),观察者内一致性检验新肩峰分型法均优于传统肩峰分型法(0.921 vs 0.448,0.890 vs 0.539)。新的肩峰形态分型法3种肩峰形态的AHD比较差异无统计学意义(H=2.186,P>0.05)。所有101例患者撞击型肩峰占比最高为45.5%,隆起型肩峰次之36.6%,平坦型肩峰占17.8%。其中撞击型肩峰患者冈上肌腱撕裂发生率为95.7%,新的肩峰分型法与冈上肌腱撕裂程度存在Spearman秩相关(rs=0.719,P<0.001)。结论:肩关节Rockwood位片可以很好的显示肩峰前外侧骨赘,基于Rockwood位片新肩峰分型法可信度高,可重复性良好,其中撞击型肩峰与冈上肌腱撕裂存在密切关联。新分型法相比传统分型以及AHD对肩袖损伤更具诊疗价值。
