移位肩峰骨折内固定手术方式的选择  

Selection of methods of internal fixation for displaced acromion fractures

作　　者：魏建军 颜世昌 杨永江 杨丰真 WEI Jian-jun;YAN Shi-chang;YANG Yong-jian;YANG Feng-zhen(Department of Orthopaedic,BenQ Medical Center,the Affiliated BenQ Hospital of Nanjing Medical University,Nanjing,Jiangsu 210019,China)

机构地区：[1]南京明基医院南京医科大学附属明基医院骨科,江苏南京210019

出　　处：《中国骨与关节损伤杂志》2022年第11期1146-1149,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨Ogawa 1型和Ogawa 2型移位肩峰骨折内固定手术方式的选择及临床疗效。方法回顾性分析自2014-12—2020-12采用手术治疗的15例移位肩峰骨折,对Ogawa 1型肩峰骨折采用2.0 mm微型锁定双钢板内固定治疗,对Ogawa 2型肩峰骨折采用2.7 mm或3.5 mm重建锁定钢板内固定治疗。术后6周内限制肩关节外展90°,根据骨愈合情况进行超过90°的外展和前举运动。结果15例均获得随访,随访时间12~94个月,中位时间58.5个月。随访期间未发生切口感染、内固定失效、骨折不愈合等并发症。骨折愈合时间8~16周,平均11.5周。末次随访时单纯肩峰骨折患者上肢功能DASH评分为3.5~20.8分,平均5.7分;合并肩关节损伤患者DASH评分为12.5~58.2分,平均18.7分;单纯肩峰骨折患者肩关节功能Constant-Murley评分为85~92分,平均87.4分;合并肩关节损伤患者Constant-Murley评分为46~85分,平均75.4分。末次随访时单纯肩峰骨折患者肩关节前举活动度为100°~150°,平均135.7°;合并肩关节损伤患者肩关节前举活动度为50°~150°,平均100.0°;单纯肩峰骨折患者肩关节外展活动度为135°~150°,平均142.9°;合并肩关节损伤患者肩关节外展活动度为65°~150°,平均113.1°。结论肩峰骨折患者常合并肩肢带结构损伤和肩关节外损伤,需积极手术治疗。Ogawa 1型肩峰骨折可采用2块平行或垂直分布的2.0 mm微型锁定钢板固定,干骺端至少4枚螺钉固定以增加整体结构强度。Ogawa 2型肩峰骨折可选择结构刚度更高的2.7 mm或3.5 mm重建锁定钢板固定。Objective To investigate the choice of internal fixation methods and clinical efficacy of displaced acromial frac-tures of Ogawa type 1 and Ogawa type 2.Methods Fifteen patients with displaced acromion fractures who underwent surgicaltreatment from December 2014 to December 2020 were retrospectively analyzed.Ogawa type 1 acromial fractures were treatedwith double 2.0 mm mini-locking plate,and Ogawa 2 acromial fractures were treated with 2.7 mm or 3.5 mm reconstructionlocking plate.Within 6 weeks after surgery shoulder abduction was restricted to 90°,and abduction and forward movement over90°were done according to bone healing.Results All 15 cases were followed up from 12 to 94 months,with a mean of 58.5months.No wound infection,internal fixation failure and nonunion occurred during the follow-up period.Fracture union timeranged from 8 to 16 weeks(mean,11.5 weeks).At last follow-up,the DASH score of patients with simple acromial fractures was3.5-20.8,with a mean of 5.7;The DASH score of patients with ipsilateral shoulder girdle injury was 12.5-58.2,with a mean of18.7.The Constant-Murley score in patients with simple acromial fractures was 85-92,with a mean of 87.4;The Constant-Mur-ley of patients with ipsilateral shoulder girdle injury was 46-85,with a mean of 75.4.The rang of motion(ROM)of shoulder for-ward flexion in patients with simple acromial fractures was 100°-150°,with a mean of 135.7°.ROM of shoulder forward flexionin patients with shoulder girdle injury was 50°-150°,with a mean of 100°.ROM of shoulder abduction in patients with simplefracture was 135°-150°,with a mean of 142.9°.ROM of shoulder abduction in patients with shoulder girdle injury was 65°-150°,with a mean of 113.1°.Conclusion Acromion fractures are frequently accompanied with ipsilateral shoulder girdle inju-ry and other injuries,which should be treated actively.Ogawa type 1 acromion fractures can be fixed with double 2.0 mm mini-locking plates with parallel or vertical distribution,to make sure that at least four screws in the

关 键 词：肩峰骨折 微型钢板 重建钢板 锁定钢板 内固定 

分 类 号：R687.3[医药卫生—骨科学]