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作 者:李仁斌[1] 林焱斌[1] 熊圣仁[1] 庄研[1] 熊国胜[1] 张怡元[1]
出 处:《中华肩肘外科电子杂志》2017年第1期29-35,共7页Chinese Journal of Shoulder and Elbow(Electronic Edition)
基 金:福州市科技局社会发展项目(2016-S-123-16)
摘 要:目的探讨后侧微创入路结合三角固定原则治疗肩胛体及肩胛颈骨折的临床疗效。方法自2012年6月至2014年12月,厦门大学附属福州第二医院采用后侧微创入路钢板内固定治疗肩胛体及肩胛颈骨折患者23例,其中男16例,女7例,平均年龄37.58岁(19~62岁)。合并损伤主要包括:多发肋骨骨折9例,血气胸和(或)肺挫伤6例,颅脑损伤5例,颈椎损伤2例,同侧锁骨骨折4例,骨盆骨折4例。采用臂、肩、手功能障碍(disabilities of the arm,shoulder and hand,DASH)评分对患者肩关节功能进行评估。结果所有患者均获得完整随访,平均随访时间17.7个月(9~36个月)。手术时间78.6min(58~121min),出血量68.3ml(50~100ml)。所有骨折均愈合,无感染、无肩关节创伤性关节炎、无异位骨化、无神经损伤等并发症。DASH评分平均为7.8分(4~21分)。结论后侧微创入路结合三角固定原则治疗肩胛体及肩胛颈骨折具有切口小、出血少、对软组织干扰小、手术时间短、手术效果好等优点。Background The scapular fracture is rarein clinic,accounting for about 0.5%-1% of fractures in the whole body.The scapular body and neck can be involved in 98%of scapular fractures.Generally,thesurgical treatment is required forscapular body fractures with glenopolar angle of less than 22°,lateral and shortening displacement of more than 3 cm and angulation displacement of more than 40°.78.1% of the scapular fractures can be treated through posterior approach.The scapula is a triangle-like flat bone: the 3 sides include the connection between mesoscapula and scapular body,the medial margin and the lateral margin;the 3 corners include the inner upper corner,the lower angle corner and the glenoid neck.According to the surgical indications of scapular neck and body fractures,two or three margins are often involved.To build a stable triangle,the author came up with the triangle theory of fixing every margin affected by fractures.In this study,a group of patients with scapular body and neck fractures was treated with minimally invasive approachin combination with triangle principle to evaluate the corresponding clinical efficacy.Methods (1)General data.From June 2012 to December 2014,23 patients (16 males and 7 females) with an average age of 37.58 years (19-62 years)were treated for the scapular body and neck fractures with plate fixation via posterior minimally invasive approach in our hospital.The associated injuries included 9 cases of multiple rib fractures,6 cases of hemopneumothorax and (or) pulmonary contusion,5 cases of craniocerebral injury,2 cases of cervical spine injury,4 cases of ipsilateral clavicle fractures and 4 cases of pelvic fractures.According to the Hardegger classification,18 cases of scapular body fractures and 5 cases of scapular neck fractures were in this group,including 3 cases of surgical neck fractures and 2 cases of fractures of spina scapulae.The average time from injury to operation was 7.8 days (5-16 days).All patients received preoperative shoulder fluoroscop
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