上肩胛悬吊带复合体双重损伤的临床分型和手术治疗策略

The classification and surgical treatment strategy of double disruption of the superior shoulder suspensory complex

目的探讨上肩胛悬吊带复合体（superior shoulder suspensory complex，SSSC）双重损伤的临床分型和手术治疗策略。方法回顾性分析2006年5月至2008年3月收治的SSSC双重损伤患者15例，男13例，女2例。年龄20-55岁，平均40．1岁。12例患者接受手术治疗，3例患者因严重合并伤接受保守治疗。根据Goss对SSSC的定义，将其双重损伤分为4型：Ⅰ型，肩胛颈骨折合并同侧锁骨中1／3骨折，共7例，5例接受锁骨骨折及肩胛颈骨折切开复位内固定术；Ⅱ型，喙突-喙锁韧带-锁骨连接体（C4连接）损伤，共1例，肩锁关节脱位行锁骨钩钢板固定，喙突骨折行空心拉力螺钉固定；Ⅲ型，喙突-肩胛盂上部分-肩峰联合部损伤，共6例，5例接受手术治疗，肩峰骨折行小“T”形钢板固定，喙突骨折行空心拉力螺钉固定；Ⅳ型，肩峰-肩锁关节-锁骨外1／3损伤，共1例，肩峰骨折行克氏针张力带固定，锁骨外113骨折行锁骨钩钢板固定。结果15例患者均获得13．2（6-24）个月随访，骨折全部愈合，平均愈合时间10．2（8-12）周。手术组随访结果Constant—Murley评分平均91．3（70-100）分，Rowe评分平均92．9（80-100）分，Herscovici评分平均14．6（12～16）分。保守组Constant—Murley评分平均58．3（55-60）分，Rowe评分平均50（35-60）分，Herscovici评分平均6．7（4-9）分。结论根据Goss对SSSC的定义对其双重损伤进行分型，并以此分型选择合适的手术方法治疗可获得满意疗效。手术治疗应以恢复SSSC的完整性和稳定性为目标来选择进行一处还是两处切开复位内固定，通常需行两处复位内固定。

Objective To discuss the clinical characteristics of different types of double disruption of the superior shoulder suspensory complex （SSSC） and their surgical treatment strategy. Methods Fifteen cases with double disruption of the SSSC between May 2006 and March 2008 were retrospectively evaluated. There were 13 males and 2 females with an average age of 40.1 （20-55） years. There were seven cases of type Ⅰ which involved the scapular neck fracture combined with ipsilateral clavicular fracture; one case of type Ⅱ which involved the clavicular-coracoclavicular ligamentous-coracoid（C4） linkage injury; six cases of type Ⅲ which involved acromion-upper glenoid-coracoid fracture; one case of type Ⅳ which involved the clavicular-acromioclavicular joint-acromial strut injury. Twelve patients were treated operatively while the remaining three with critical associated injuries were treated conservatively. The clinical outcomes were evaluated according to the Constant score, Rowe score and Herscovici score. Results All cases were followed for an average of 13.2 （6-24） months. All fractures healed for a mean time of 10.2 （8-12） weeks. The mean Constant score for the surgical group was 91.3. The mean Rowe score for the surgical group was 92.9. The mean Herscovici score was 14.6. Conclusion The classification of double disruption of SSSC injury was established on Goss＇ description. The surgical treatment should restore the integrity and stability of the SSSC in order to maintain the shoulder girdle function.