浮肩损伤的临床特征和治疗

目的 总结浮肩损伤（floating shoulder injury，FSI）的临床特征和治疗效果。方法1993年1月-2004年9月收治浮肩损伤患者8例，除2例行锁骨固定带固定外，其余6例均行手术治疗，其中单纯行锁骨切开复位重建钢板内固定1例，同时行肩胛骨内固定5例。受伤至手术时间为2h～7d，平均3．5d，术后6个月对患肩功能进行Constant评分判定疗效，并对浮肩损伤的临床特征和治疗进行总结。结果6例患者经过6个月～3年（平均11个月）的随访，锁骨和肩胛骨骨折均愈合，肩关节活动范围无明显受限，但有2例患者在举重物时肩关节有轻度的疼痛，1例患侧上肢肌力较对侧稍减弱。术后6个月患肩功能Constant评分平均为93分。结论浮肩损伤多为高能量暴力所致的不稳定性肩胛带损伤，在治疗方案上尚存争议。但对移位明显的浮肩损伤以及有伴发伤的浮肩损伤进行手术治疗是必要的。

Clinical features and treatment of floating shoulder injury

Objective To summarize clinical features and results of the floating shoulder injury (FSI). Methods From January 1993 to September 2004, eight cases with FSI were admitted to our hospital and treated with clavicle bands fixation (two cases) and reconstructive plates (six cases). Of six cases treated with reconstructive plates, the clavicle was fixed alone in one case and clavicle and scapular fixed simultaneously in five. The duration from injury to operation varied from two hours to seven days (average 3.5 days). The results were evaluated according to the Constant score. Results The follow up for average of 11 months (6-36 months) showed that the fractures of the clavicle and the scapular neck were union with insignificant limitation for range of the shoulder motion in six cases but that two cases had mild pain at the course of elevation and one had weaker muscle force compared with the contralateral shoulder. Six months after operation, the average value of constant score was 93. Conclusions FSI is instable injury of the shoulder girdle usually caused by high energy violence. Although the suitable treatment of the floating shoulder injuries gives rise to much controversy, it is still necessary to perform operation when FSI is accompanied by apparent displacement or other injuries.