浮肩损伤的手术治疗策略
钟诚,李宇明,焦根龙,周霖,刘彦
摘要(Abstract)：
[目的]探讨浮肩损伤机制、临床特征和手术治疗策略。[方法]回顾性分析手术治疗浮肩损伤患者18例,男15例,女3例;年龄23~65岁,平均45.0岁。患者均行手术治疗,通过X线片评估骨折愈合情况,记录患者末次Constant评分和Herscovici疗效评价标准对肩关节功能进行评估。[结果]所有患者获得平均21个月随访,12周内均达到骨性愈合,Constant评分平均分为84.6分,Herscovici疗效评价标准,优9例,良6例,可2例,差1例,优良率83.3%。[结论]根据浮肩损伤分型,复位、固定肩胛骨外侧柱是治疗的关键,选择性重建肩部稳定性是治疗浮肩损伤的有效方法。
关键词(KeyWords)： 锁骨;肩胛骨;浮肩损伤;骨折内固定术
基金项目(Foundation): 广东省中医药局科研计划项目(编号:20141253);; 江门市科技计划项目(编号:2015751)
作者(Author): 钟诚,李宇明,焦根龙,周霖,刘彦
参考文献(References)：
- [1]Michener LA,Mcclure PW,Sennett BI.American shoulder and elbow surgeons standardized shoulder assessment form,patient self-report section reliablitiy,validity,and responsivenss[J].Shoulder Elbow Surg,2002,11(6):587-594.
- [2]Wong KL,Ramsey ML,Williams GR Jr.Scapular fractures.Orthopedic knowledge update:shoulder and elbow[J].J Acad Orthop Surg,2002,10(3):227-236.
- [3]Sudkamp NP,Jaeger N,Bornebusch L,et al.Fractures of the scapula[J].Acta Chir Orthop Traumatol Cech,2011,78(4):297-304.
- [4]Ban I,Troelsen A,Christiansen DH,et al.Standardised test protocol(Constant Score)for evaluation of functionality in patients with shoulder disorders[J].Dan Med J,2013,60(4):A4608.
- [5]Herscovici D Jr,Fiennes AG,Allgower M,et al.The floating shoulder:ipsilateral clavicle and scapular neck fractures[J].J Bone Joint Surg Br,1992,74(3):362-364.
- [6]Veysi VT,Mittal R,Agarwal S,et al.Muliple trauma and scapula fractures:so what[J].J Trauma,2003,55(6):1145-1147.
- [7]Kostler W,Strohm PC,Hauschild O,et al.Complex injuries of the shoulder-floating shoulder[J].Acta Chir Orthop Traumatol Cech,2006,73(4):264-267.
- [8]Kim KC,Rhee KJ,Skin HD,et al.Can the glenopolar angle be used to predict outcome and treatment of the floating shoulder[J].J Trauma,2008,64(1):174-178.
- [9]朱吉桂,刘宏鸣,姜郁,等.浮肩损伤手术内固定的临床疗效分析[J].南京医科大学学报,2013,33(9):1291-1293.
- [10]李国胜,王宝军,刘长贵,等.漂浮肩损伤的手术治疗[J].中国骨与关节损伤杂志,2013,28(7):654-655.
- [11]陈健荣,吴峰,张宏宁,等.两种内固定术式治疗浮肩损伤60例疗效对比[J].中国矫形外科杂志,2014,22(18):1711-1714.
- [12]Yadav V,Khare GN,Singh S,et al.A prospective study comparing conservative with operative treatment in patients with a floating shoulder including assessment of the prognostic value of the glenopolar angle[J].Bone Joint J,2013,95(6):815-819.
- [13]Markus D,Schofer,Axel C,et al.Fractures of the scapula:longterm results after conservative treatment[J].Arch Orthop Trauma Surg,2009,129(11):1511-1519.
- [14]段连鸿,张鹏,黄继锋,等.肩锁关节脱位并肩胛颈骨折行钢板内固定的生物力学研究[J].华西医学,2014,29(11):2028-2031.
- [15]Cole PA,Freeman G,Dubin JR.Scapula fractures[J].Curr Rev Musculoskelet Med,2013,6(1):79-87.
- [16]傲荣广,禹宝庆,黄建明,等.外侧柱单钢板固定治疗肩胛骨体部骨折的初步疗效[J].中华创伤骨科杂志,2014,16(10):839-842.