浮肩损伤患者的手术治疗36例报告  

A 36-case report:surgical treatment of floating shoulder injuries

作　　者：闫伟强[1] 张敏 

机构地区：[1]广东省江门市中山大学附属江门医院创伤科,529000

出　　处：《中国骨与关节杂志》2013年第8期457-460,共4页Chinese Journal of Bone and Joint

摘　　要：目的探讨手术治疗浮肩损伤的方法和疗效。方法2005年7月至2012年7月，我们经治浮肩损伤患者36例，均行锁定钢板内固定手术治疗。术前对后盂极角（GPA）进行了测量。结果左肩21例，右肩15例。交通伤24例，坠落伤5例，重物压砸伤3例，挤压伤4例。合并臂丛神经损伤2例，颅脑外伤3例，颈髓损伤1例，肋骨骨折、血气胸13例，合并其他部位多发骨折5例，肩胛伤神经挫伤1例。受伤至手术3～35天，平均7天。锁骨干骨折21例，肩锁关节脱位15例。肩胛骨解剖颈骨折7例，外科颈骨折17例，外科颈伴肩胛冈骨折6例，伴肩胛盂前部骨折1例，伴肩峰骨折4例，伴喙突骨折2例。Miller分型，I型7例，II型17例，III型7例，IV型4例。V型2例。术后随访3个月至2．5年，平均15个月。35例骨折全部愈合。1例经二期手术愈合。术前GPA平均15°，术后平均35°，骨折部位得到解剖复位。术后肩关节功能采用Hardegger标准评定，优17例，良14例，可5例，优良率86％。结论手术治疗浮肩损伤恢复了肩胛颈的解剖结构，恢复了肩关节上方悬吊结构，为早期肩关节功能锻炼提供了基础，有利于最大程度的恢复患肩功能。Objective To investigate the methods and effects of surgical treatment of floating shoulder injuries. Methods 36 patients with floating shoulder injuries were treated from July 2005 to July 2012. All patients underwent locking plate fixation. The glenopolar angle （ GPA ） was measured preoperatively and postoperatively. Results Injuries in the left shoulder occurred in 21 cases, and injuries in the right shoulder in 15 cases. There were 24 cases of traffic injuries, 5 cases of falling injuries, 3 cases of crash injuries of heavy weights, 4 cases of crush injuries, 2 cases of combined brachial plexus nerve injuries, 3 cases of craniocerebral trauma, 1 case of cervical spinal cord injuries, 13 cases of rib fractures and hemopneumothorax, 5 cases of combined multiple fractures in other parts and 1 case of scapular injuries and nerve contusion. The mean time from primary injury to operation was 7 days （ range; 3-35 days ）. There were 21 cases of fractures of the clavicle shaft, 15 cases of acromioclavicular joint dislocation, 7 cases of anatomical neck fractures of the scapula, 17 cases of surgical neck fractures, 6 cases of surgical neck fractures combined with fractures of the spina scapulae, 1 case of combined anterior scapular glenoid fractures, 4 cases of combined acromion fractures and 2 cases of combined coracoid fractures. According to Miller＇s classification, there were 7 cases of type l, 17 cases of type II, 7 cases of type III, 4 cases of type IV and 2 cases of type V. All patients were followed up for a mean period of 15 months （ range; 3-30 months ） postoperatively. Fracture healing was achieved in all patients, and which was finally achieved in 1 patient after the second-stage operation. Preoperatively the mean GPA was 15°, and 35° postoperatively. Anatomic reduction was achieved in all fractures. According to Hardegger＇s evaluation of postoperative shoulder joint function, 17 patients showed excellent results, 14 good and 5 fair, and the excellent and good rate was 86%. Conclusions Sur

关 键 词：肩关节 内固定器 骨折固定术 内 创伤和损伤 

分 类 号：R687.3[医药卫生—骨科学]