摘要
目的总结肩关节上方悬吊复合体两部分以上损伤的分型及手术治疗方法。方法2006年6月至2010年3月，治疗26例肩关节上方悬吊复合体两部分以上损伤患者，男18例，女8例；年龄16～80岁，平均42岁。其中锁骨骨折合并肩胛颈骨折9例（I型），锁骨远端骨折或脱位伴喙锁韧带、肩锁关节损伤10例（Ⅱ型），锁骨远端骨折合并肩关节上方悬吊复合体其余部分损伤7例（Ⅲ型）。伤后至手术时间为3-10d，平均6．4d。肩胛颈及肩胛盂骨折均以重建钢板及空心钉固定，肩峰骨折以重建钢板及空心钉固定，锁骨骨折以重建钢板或钩状钢板固定，喙突骨折以空心钉固定，所有韧带损伤均行一期修复。术后随访，监测骨折愈合情况并指导功能康复。骨折愈合后以Rowe及Constant-Mudey评分系统对术后疗效进行评价。结果患者均获得随访，随访时间12-32个月，平均18．7个月。骨折愈合时间6～12周，平均8-2周。术后无一例出现肩峰下撞击征等并发症。患者肩关节均自觉处于稳定状态。2例患者出现三角肌肌力下降，3例出现肩部疲劳感及酸痛感。Rowe评分为71～97分，平均89．7分，其中优18例、良5例、可3例；Constant．Mudey评分为70-100分，平均92．4分，其中优16例、良6例、可4例。结论肩关节上方悬吊复合体两部分以上损伤分为三型，可采用重建钢板及空心钉固定进行治疗。
Objective To summarize the classification and surgical treatment of double or above disruptions of the superior shoulder suspensory complex （SSSC） retrospectively. Methods From June 2006 to March 2010, 26 consecutive patients with double or above disruptions of the SSSC were treated and entered in the study, including 18 males and 8 females with an average age of 42 years （range, 16-80）. All patients received surgical treatment, these included clavicle fracture and scapular neck fracture in 9 cases （type I）, distal clavicle fracture or dislocation and coracoclavicular ligament and acmmioclavicular joint injury in 10 （type II）, distal clavicle fracture and other injuries in the SSSC in 7 （type III）. The duration from injury to surgery was 6.4 days （range, 3-10）. Scapular neck fracture and scapular area dishes fracture were fixed with reconstructive plate and canuiated screws, acromial fracture was treated with reconstructive plate and canulated screws, clavicle fracture was fixed with reconstructive plate or hook plate, coracoid fracture was fixed with canulated screw. All patients were treated with primary repair for ligament injuries. The surgery effect was assessed with Rowe and Constan-Mudey systems after the fractures reunion. Results All patients were successfully followed up, and the average time was 18.7 months （range, 12-32）. Fractures were healed with an average of 8.2 weeks （range, 6-12 weeks）. There was no inferior shoulder knocking syndrome after surgery. Patients all felt shoulder in a stable status. Two patients appeared dehoid muscle power decline, 3 appeared shoulder fatigue and aching pain. The average score was 89.7 （range, 71-97） according to the Rowe system. Eighteen cases were grade as excellent, 5 as good, and 3 as fair. The average score was 92.4 （range, 70-100） according to the Constant-Murley system. Sixteen cases were grade as excellent, 6 as good, and 4 as fair. Conclusion Double or above disruptions of the SSSC can be classified into three types, and surgical treatment with constructive plate and canulated screws for them is a good option.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2011年第7期729-733,共5页
Chinese Journal of Orthopaedics
关键词
肩关节
锁骨
骨折固定术
内
Shoulder joint
Clavicle
Fracture fixation
internal
