切开复位内固定治疗合并喙突骨折的上肩胛悬吊复合体多重损伤  

Open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex with coracoid process fracture

作　　者：姚晓克[1] 伍玲娜 李建华[1] 黄文刚[1] 段鑫[1] 顾祖超[1] 王跃[3] YAO Xiaoke;WU Lingna;LI Jianhua;HUANG Wengang;DUAN Xin;GU Zuchao;WANG Yue(Department of Orthopedics,Chengdu First People's Hospital,Chengdu Sichuan,610041,P.R.China;Intensive Care Unit,Chengdu First People's Hospital,Chengdu Sichuan,610041,P.R.China;Department of Orthopedics,Sichuan Academy of Medical Science·Sichuan Provincial People's Hospital,Chengdu Sichuan,610072,P.R.China)

机构地区：[1]成都市第一人民医院骨科,成都610041 [2]成都市第一人民医院重症医学科,成都610041 [3]四川省医学科学院·四川省人民医院骨科,成都610072

出　　处：《中国修复重建外科杂志》2020年第3期347-351,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川省医学科研课题计划(S18059)。

摘　　要：目的探讨切开复位内固定治疗合并喙突骨折的上肩胛悬吊复合体(superior shoulder suspensory complex,SSSC)多重损伤的疗效。方法2014年1月-2018年10月,采用切开复位内固定治疗22例合并喙突骨折的SSSC多重损伤患者。男16例,女6例;年龄24~72岁,平均36.6岁。致伤原因:摔伤10例,交通事故伤5例,高处坠落伤7例。均为新鲜闭合损伤。受伤至手术时间2~17 d,平均6.9 d。X线片及CT示喙突骨折合并锁骨骨折14例、肩锁关节脱位12例、肩峰骨折5例,其中SSSC 2处损伤14例、3处损伤7例、4处损伤1例。结果术后患者切口均Ⅰ期愈合。患者均获随访,随访时间10~24个月,平均14.1个月。X线片示骨折均愈合,愈合时间6~12个月,平均6.2个月;肩锁关节位置正常,未出现内固定失效、骨不连等并发症。末次随访时,根据美国加州大学洛杉矶分校(UCLA)肩关节评分系统,获优15例,良5例,差2例,优良率90.9%。结论切开复位内固定治疗合并喙突骨折的SSSC多重损伤固定牢靠,配合术后积极康复,可以加速肩关节功能恢复,取得满意治疗效果。Objective To investigate the effectiveness of open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex(SSSC)with coracoid process fracture.Methods Between January 2014 and October 2018,22 patients with multiple injuries of SSSC with coracoid process fracture were treated by open reduction and internal fixation.There were 16 males and 6 females,aged from 24 to 72 years with an average age of 36.6 years.There were 10 cases of falling injury,5 cases of traffic accident injury,and 7 cases of falling from height injury.All of them were fresh closed injuries.The time from injury to operation ranged from 2 to 17 days with an average of 6.9 days.Both X-ray film and CT showed the coracoid process fracture complicated with clavicular fracture in 14 cases,acromioclavicular joint dislocation in 12 cases,and acromioclavicular fracture in 5 cases.There were 14 cases of two places of SSSC,7 cases of three places of SSSC,and 1 case of four places of SSSC.Results All incisions healed in primary stage after operation.All patients were followed up 10-24 months with an average of 14.1 months.X-ray films showed that all fractures healed and the acromioclavicular joint was normal.The healing time ranged from 6 to 12 months,with an average of 6.2 months.No complications such as internal fixation failure and nonunion occurred.According to University of California Los Angeles(UCLA)shoulder scoring system,the shoulder joint function was rated as excellent in15 cases,good in 5 cases,and poor in 2 cases at last follow-up.The excellent and good rate was 90.9%.Conclusion Open reduction and internal fixation for treatment of multiple injuries of SSSC with coracoid process fracture is firm and reliable.Combined with active postoperative rehabilitation program intervention,it can accelerate the recovery of shoulder joint function and achieve satisfactory effectiveness.

关 键 词：喙突骨折 上肩胛悬吊复合体 多重损伤 切开复位 内固定 

分 类 号：R687.3[医药卫生—骨科学]