肩胛盂骨折的手术治疗

Operative treatment for glenoid fractures

目的探讨肩胛盂骨折的手术指征及疗效。方法回顾肩胛骨骨折患者32例,其中涉及肩胛盂骨折19例。根据Ideberg分类系统进行分类,Ⅰ型2例,Ⅱ型7例,Ⅲ型3例,Ⅳ型5例,Ⅴ型2例。其中4例为“浮肩”,1例合并完全性臂丛神经损伤。根据骨折的类型,3例选择前入路,其余均为后入路。利用重建钢板结合螺钉行切开复位内固定。结果患者平均随访26个月,对双肩均予以Constant评分,根据患肩占正常侧功能的百分比计算,患肩平均分数为92.6%,肩关节平均前屈度数达152°,外展度达87°,外旋度达35°。结论对于肩胛骨波及肩胛盂的骨折除了遵循关节内骨折的治疗原则外,同时应考虑是否影响肩关节稳定性。手术指征选择恰当,固定可靠,结合完善的术后康复,可取得良好的临床效果。

Objective To evaluate the indications and clinical results of the surgical treatment for glenoid fractures. Methods 32 cases of scapular fractures were reviewed, including 19 cases of glenoid ones. According to Ideberg classification system, there were 2 cases of Type Ⅰ, 7 Type Ⅱ, 3 Type Ⅲ, 5 Type Ⅳ, and 2 TypeⅤ. Among them, 4 were “floating shoulder”, 1 was complete palsy of brachial plexus. Depending on the fracture type, 3 cases were operated on through the anterior approach, while the others through the posterior approach. All cases were fixed with reconstruction plate and lag screws. Results Mean follow up period was 26 months. Mean Constant score of the injured shoulder was 92.6%. The mean range of active abduction of the shoulder was 87 degrees,the mean range of flexion 152 degrees, and mean range of external rotation 35 degrees. Conclusions In treatment of the scapular fracture involving glenoid cavity, both the stability of the shoulder and the principles of intra articular fracture treatment should be taken into consideration. Proper command of the indication, open reduction, stable fixation, and postoperative rehabilitation can get good results,