浮肩损伤的治疗方法选择  

The choice of effective methods for treatment of floating shoulder injury

作　　者：黄哲元[1] 陈长青[1] 郭林新[1] 丁真奇[1] 陈志文[1] 

机构地区：[1]解放军第175医院骨科,福建漳州363000

出　　处：《临床骨科杂志》2006年第6期528-530,共3页Journal of Clinical Orthopaedics

摘　　要：目的 探讨浮肩损伤治疗方法的选择。方法 52例浮肩损伤患者行非手术治疗15例，手术治疗37例，并对其进行回顾性对比分析。采用Herscovici功能评估方法；影像学检查主要在肩关节正位X线片上测量盂极角（GPA）。结果 48例获8个月～16年随访。非手术组：随访13例，优2例，良3例，可2例，差6例；7例GPA〉20°，6例GPA〈20°。手术组：随访35例，其中单纯锁骨或肩锁关节固定26例：优16例，良3例，可5例，差2例；20例GPA〉20°，6例GPA〈20°。肩胛颈、锁骨联合手术9例：优4例，良2例，可2例，差1例；8例GPA〉20°，1例GPA〈20°。结论浮肩损伤手术治疗明显优于非手术治疗，且多数病例可采取单纯固定锁骨或肩锁关节的手术方案，但对于锁骨骨折合并同侧严重移位的肩胛颈骨折宜采用联合手术治疗，以重建肩关节稳定，促进关节功能的早期康复。Objective To explore the choice of effective methods for treatment of floating shoulder injury. Methods A retrospective analysis of 52 patients with floating shoulder injury has been done. 15 were treated by non-operation, 37 by operation. The clinical examination has been done and the X-ray films were taken to measure glenopolar angle （GPA）. Herscovici＇s score was adopted. Results Forty-eight patients were followed up from 8 months to 16 years. Among 13 patients treated by non-operation, Herscivici score showed that 2 cases achieved excellent results,3 cases good ,2 cases fair and 6 cases poor and the X-ray film results showed that there were 7 cases of GPA 〉 20° and 6 cases of GPA 〈 20°. Of 26 patients treated by operation （ clavicle or acromioclavicular fixation ） , Herscivici score showed that 16 cases achieved excellent results, 3 cases good ,5 case fair and 2 cases poor and the X-ray film results showed that there 20 cases of GPA 〉 20° and 6 case of GPA 〈 20°. Of 9 patients treated by operation （ clavicle and scapular neck） , Herscivici score showed that 4 cases achieved the excellent results, 2 cases good ,2 case fair and 1 cases poor and the X-ray film results showed that there 8 cases of GPA 〉 20°and 1 case of GPA 〈 20°. Conclusions Operation treatment of the floating shoulder injury is superior to Non-operation obviously, and most of the floating shoulder injury can be treated with operation of clavicle or AC joint. But for a few of floating shoulder injury with Severe displaced fracture,it is better to be treated with operation of clavicle and scapular neck to reconstruct the stability of shoulder and facilitate healing of shoulder joint function.

关 键 词：浮肩损伤 肩胛颈骨折 锁骨骨折 骨折固定术 内 

分 类 号：R683[医药卫生—骨科学] R687.3[医药卫生—外科学]