锁骨及肩胛骨双重内固定并术中复位盂极角治疗浮肩损伤  

Double internal fixations of clavicle and scapula and intraoperative reduction of glenopolar angle for treatment of floating shoulder injuries

作　　者：薛建强 张瀚文 贾乐 胡鑫 鲁晓波 葛建华 XUE Jianqiang;ZHANG Hanwen;JIA Le;HU Xin;LU Xiaobo;GE Jianhua(Department of Bone&Joint Surgery,Affiliated Hospital of Southwest Medical University,Luzhou Sichuan,646000,P.R.China;Sichuan Provincial Laboratory of Orthopaedic Engineering,Luzhou Sichuan,646000,P.R.China)

机构地区：[1]西南医科大学附属医院骨与关节外科,四川泸州646000 [2]四川省骨科工程试验室,四川泸州646000

出　　处：《中国修复重建外科杂志》2021年第1期76-81,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用锁骨及肩胛骨双重内固定并术中复位盂极角治疗浮肩损伤的临床疗效。方法 2010年1月—2019年6月采用锁骨及肩胛骨双重内固定并术中复位盂极角治疗13例浮肩损伤患者。男11例,女2例;年龄25~65岁,平均48岁。致伤原因:高处坠落伤2例,交通事故伤3例,重物砸伤2例,其他伤6例。浮肩损伤分型:Ⅰ-B-3型2例,Ⅰ-C-2型1例,Ⅰ-C-3型1例,Ⅱ-B-2型3例,Ⅱ-B-3型1例,Ⅱ-B-4型1例,Ⅱ-C-2型2例,Ⅱ-C-4型1例,Ⅱ-D-3型1例。均为单侧锁骨骨折伴肩胛颈骨折,肩关节悬吊复合体(superior shoulder suspensory complex,SSSC)损伤1~4处。受伤至手术时间7~17 d,平均12 d。手术前后测量盂极角、肩峰下间隙、肩胛盂前后倾斜角、肩胛盂上下倾斜角;采用Constant-Murly评分和Herscovici评分评价肩关节功能恢复情况。结果术后切口均Ⅰ期愈合,无感染等术后早期并发症发生。13例均获随访,随访时间12~48个月,平均25.2个月。患者锁骨及肩胛骨均获骨性愈合,愈合时间分别为平均6个月和4个月。均未出现骨不连、肩关节畸形、钢板断裂或内固定失效、肩峰撞击综合征、冰冻肩等并发症。末次随访时,盂极角、肩峰下间隙、肩胛盂前后倾斜角和肩胛盂上下倾斜角均较术前明显纠正(P<0.05);Constant-Murly评分中疼痛、活动度、日常功能、肌力评分及总分均较术前明显提高(P<0.05);根据Herscovici评分标准评价肩关节功能,获优8例、良3例、可2例,优良率84.6%。结论采用锁骨及肩胛骨双重内固定稳定SSSC并术中复位盂极角治疗浮肩损伤可获得良好疗效。Objective To investigate the effectiveness of double internal fixations of clavicle and scapula and intraoperative reduction of glenopolar angle in the treatment of floating shoulder injuries.Methods Between January 2010 and June 2019,13 patients with floating shoulder injury were treated with double internal fixation of clavicle and scapula and intraoperative reduction of glenopolar angle.There were 11 males and 2 females with an average age of 48 years(range,25-65 years).The causes of injury included falling from height in 2 cases,traffic accident injury in 3 cases,heavy object injury in 2 cases,and other injuries in 6 cases.There were 2 cases ofⅠ-B-3 type,1 case ofⅠ-C-2 type,1 case ofⅠ-C-3 type,3 cases ofⅡ-B-2 type,1 case ofⅡ-B-3 type,1 case ofⅡ-B-4 type,2 cases ofⅡ-C-2 type,1 case ofⅡ-C-4 type,and 1 case ofⅡ-D-3 type according to the classification of floating shoulder injury.All patients had unilateral clavicle fracture with scapular neck fracture,1-4 superior shoulder suspensory complex(SSSC)injuries.The time from injury to operation was 7-17 days,with an average of 12 days.The glenopolar angle,subacromail space,anteroposterior inclination angle of scapular glenoid,scapular glenoid up and down angle were measured before and after operation;Constant-Murly score and Herscovici score were used to evaluate the recovery of shoulder joint function.Results All incisions healed by first intention,and there was no early postoperative complications such as infection.All 13 cases were followed up 12-48 months,with an average of 25.2 months.Both the clavicle and the scapula had bone union,and the average healing time was 6 months and 4 months respectively.There were no complications such as nonunion,shoulder deformity,plate fracture or failure of internal fixation,acromion impingement syndrome,and frozen shoulder.At last follow-up,the glenopolar angle,subacromail space,anteroposterior inclination angle of scapular glenoid,and scapular glenoid up and down angle were all corrected significantly(P<0.05).

关 键 词：浮肩损伤 内固定 肩关节悬吊复合体 锁骨 肩胛骨 盂极角 

分 类 号：R687.4[医药卫生—骨科学]