肩胛盂移位及成角在肩胛颈骨折治疗中的意义  

Significances of displacement and angulation of the glenoid in treatment of scapular neck fracture

作　　者：吴剑宏[1] 张秋林[1] 纪方[1] 汪滋民[1] 唐昊[1] 王万宗[1] 邓迎生[1] 杜明奎[1] 汤旭日[1] 汪方[1] 王秋根[1] 

机构地区：[1]第二军医大学长海医院骨科,上海市200433

出　　处：《中华创伤骨科杂志》2005年第9期812-816,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨肩胛盂移位及成角在肩胛颈骨折治疗中的意义。方法回顾分析自2000年1月～2005年1月收治的9例伴有肩胛盂移位及成角的肩胛颈骨折治疗的临床资料。采用前后位X线片检查,辅以CT检查测量肩胛盂移位及成角畸形。采用Goss等的分型方法:ⅡA型5例,ⅡB型4例。伴有合并损伤者7例。肩肘吊带保守治疗2例,通过Judet入路重建钢板内固定手术治疗7例。结果9例患者7例获得随访,随访5个月～4年,平均28.6个月。根据Constant疗效评价标准,优3例,良3例,差1例,优良率为85.7%。远期主要并发症包括,肩关节疼痛3例,肌力下降及外展活动受限4例,肩关节不稳定1例。结论①肩胛颈骨折多由高能暴力所致,合并损伤发生率很高,容易漏诊。②正确的X线摄片及CT检查有助于明确骨折类型和选择治疗方法。③肩胛颈骨折肩胛盂移位超过1cm或成角超过40°应行手术治疗。④手术治疗是一种安全有效的方法,术后正确的康复训练对肩关节功能恢复至关重要。Objective To explore significances of displacement and angulation of the glenoid in treatment of the scapular neck fracture. Methods 9 cases of scapular neck fracture, who were complicated with displacement and angulation of the glenoid, received operative and nonoperative treatment in our hospital from 2000 to 2005. Their clinic data were retrospectively analyzed. X-ray of AP view and CT were taken in examination to measure the dis- placement and angulation of the scapular neck. According to Goss classification for scapular neck fractures, there were 5 cases of ⅡA, and 4 cases of ⅡB. 7 cases had associated injuries. According to the fracture patterns, 2 cases were treated with shoulder-elbow sling, and 7 cases were treated with surgical reconstruction plates through Judet＇s approach. Results 7 patients were followed up with an average of 28.6 months. According to Constant evaluation, 3 cases were excellent, 3 good and 1 poor. Shoulder pain was found in 3 cases of the series, degenerated muscle strength and limited motion in 4 cases, and shoulder joint instability in 1 case. Conclusions As scapular neck fractures are caused by high-energy violence with a high incidence of serious associated injuries, it is likely to be overlooked at the early stage. Correct X-ray and CT examinations are helpful in the early diagnosis. The scapular fracture, when the glenoid displacement is more than I cm or the angular displacement is more than 40°, should be treated with operation. Open reduction and internal fixation is a useful and safe treatment of the displaced fractures of the scapula. Appropriate rehabilitation is essential for the functional recovery of the shoulder.

关 键 词：肩胛颈 骨折 诊断 手术治疗 骨折固定术 内 肩胛颈骨折 成角畸形 骨折治疗 肩胛盂 移位 

分 类 号：R683[医药卫生—骨科学]