浮肩损伤的手术治疗

Surgical treatment of floating shoulder injury

目的探讨手术治疗浮肩损伤的方法和疗效。方法2001年1月-2007年12月收治24例浮肩损伤患者。按黄长明等的分类：A型（同侧肩胛颈骨折＋锁骨干骨折）14例；B型（同侧肩胛颈骨折＋锁骨外侧端骨折）6例；C型（同侧肩胛颈骨折＋肩锁关节脱位）4例。均行手术治疗，其中锁骨或肩锁关节固定7例，锁骨或肩锁关节和肩胛颈部固定17例。并对手术前后盂极角（GPA）进行测量。结果术前GPA≥30°5例，GPA200～29°8例，GPA〈20°11例。术后GPA≥30019例；GPA20°～29°5例，均为单纯固定锁骨者；术后GPA较术前有明显改善。随访时间为3个月至4年，平均16个月；骨折愈合时间为11—27周，平均15周。肩关节功能采用Hardegger功能评定标准评定：优13例，良9例，可2例。结论浮肩损伤为肩关节悬吊复合体结构的严重损伤，积极切开复位内固定为早期功能锻炼提供基础，有利于肩关节功能的恢复。

Objective To explore method and outcomes of surgical treatment for floating shoulder injuries （FSI）. Methods Twenty-four patients with FSI were treated from January 2001 to December 2007. According to HUANG Chang-ming＇s classification, these cases were classified into three FSI types： 14 cases of type A （ipsilateral fractm＇es of the scapular neck and clavicle shaft）, 6 cases of type B （ipsilateral fractures of the scapular neck and distal part of the clavicle）, and 4 cases of type C （ ipsilateral fractures of the scapular neck and acromioclavicular joint dislocation ）. All of them were surgically treated. Fixation of tile clavicle or acromioclavicular joint was carried out in 7 cases. Fixation of file clavicle or acromioclavicular joint combined with scapular neck fixation was done in 17 cases. The glenopolar angle （GPA） was measured preoperatively and postoperatively in all cases. Results Preoperatively there were 5 cases with GPA ≥ 30°, 8 cases with GPA 20°- 29°, 11 cases with GPA 〈 20°. Postoperatively 19 cases had GPA 1〉 3（7, while 5 cases had GPA 20° - 29°. GPA of the affected shoulders was significantly improved after the surgery （ P 〈 0.05 ）. All patients were followed up for 3 months to 4 years （ average 16 months）. The mean fracture healing time was 15 weeks （range ll to 27 weeks）. According to Hardegger functional evaluation system the results were grades as excellent in 13 cases, good in 9 cases and fair in 2 cases. Conclusion Floating shoulder injury is the severe disruption of superior suspensory shoulder complex. Surgical treatment with open reduction and internal fixation is the basic for early rehabilitation which is critical to the recover of shoulder functions.