不稳定肩胛颈骨折的手术治疗

目的 探讨不稳定肩胛颈骨折的手术治疗方法及疗效. 方法对2001年6月至2007年11月手术治疗且获得随访的13例不稳定肩胛颈骨折患者资料进行回顾性分析,其中男10例,女3例;左侧8例,右侧5例.单纯肩胛颈解剖颈骨折8例,肩胛颈骨折同时合并肩关节悬吊复合体损伤5例.手术采用肩关节后方入路,于因下肌与小测肌间隙进入,沿肩胛骨外缘到肩胛颈后方,复位固定肩胛颈骨折,同时固定合并的锁骨骨折、肩锁关节脱位及肩峰骨折.本组12例周定肩胛颈骨折的患者术前关节孟均向上倾斜,平均22.7°.采用Constant-Murley绝对值评分方法评价疗效. 结果 13例患者术后获平均45.1个月(10～90个月)随访.Constant-Mudey绝对值评分平均为81.2分(40～98分),平均前屈上举147.7°;优6例,良3例,可2例,差2例.术后12例固定肩胛颈骨折患者关节面向上倾斜平均为5.0°. 结论肩胛颈骨折的移位程度是影响预后的主要因素,采用肩关节后方入路复位固定移位的肩胛颈骨折可获得良好的临床效果.

Operative treatment of the unstable scapular neck fracture

Objective To explore factors influencing the restdts of operative treatment of unstable scapular neck fractures. Methods We reviewed 15 patients who had been diagnosed as the unstable scapular neck fracture and received operation from June 2001 to November 2007 in our department. Of them, 13 had full follow-up data, with a mean follow-up time of 45.1 (10 to 90) months. There were 8 cases of anatomic scapular neck fracture and 5 cases of surgical scapular neck fracture combined with injury to the superior shoulder suspensory complex. The shoulder posterior approach was adopted, exposing the fracture site between the in-fraspinatus and teres minors interval, to fix the scapular neck fracture along the scapular lateral border and si-multaneously fix the combined clavicle fracture, dislocation of the acromioclavicular joint and acromial process fracture. The results were evaluated by the absolute value of Constant-Murley rating system. Results The average absolute Constant-Murley score was 81.2 (40-98) points. Nine cases were evaluated as excellent and good, 2 cases as fair, and 2 cases as poor. The average forward elevation was 147.7°. Conclusions The degree of displacement is the main factor affecting the prognosis of the scapular neck fracture. Reduction and fixation of the displaced scapular neck fracture is the key to achieving good results.