上肩部悬吊带复合体稳定性在浮肩损伤治疗方法选择中的意义

Treatment of floating shoulder injury based on the stability of the superior shoulder suspensory complex

目的探讨根据上肩部悬吊带复合体（superior shoulder suspensory complex，SSSC）的稳定性来选择浮肩损伤（floating shoulder injury，FSI）治疗方法的临床价值。方法自1999年1月至2006年9月共收治34例FSI患者。男22例，女12例；平均年龄45（24-67）岁。根据SSSC的稳定性，结合肩胛颈骨折的Miller分型来选择具体手术治疗方案。分别采取了固定锁骨骨折、锁骨肩峰端骨折、肩锁关节脱位，固定肩胛颈骨折或二者同时固定的方式，并对8例患者利用自体半腱肌重建喙锁韧带，13例患者直接缝合修复肩锁韧带及关节囊，3例合并肩峰骨折者行内固定。结果术后平均随访23（12-72）个月，Herseovici评分系统评价肩关节功能，优21例（61．8％），良9例（26．5％），可3例（8．8％），差1例（2．9％）。肩关节主动外展或屈曲范围〉120°者24例，90°-120°者8例，〈90°者2例。术后遗留肩关节僵硬5例，肩关节疼痛6例。结论FSI患者SSSC组成部分的损伤及其稳定性的正确评估，对于具体手术方案的选择具有指导意义，而FSI患者SSSC稳定性的重建与否直接影响其临床疗效。

Objective To explore the outcome and significance of the stability of the superior shoulder suspensory complex （SSSC） in treating floating shoulder injury （FSI）. Methods Between January 1999 and September 2006, 34 patients with FSI were treated. There were 22 male and 12 female patients, with an average age of 45 （range, 24 to 67） years. The treating methods were chosen based on the stability of the SSSC and the Miller type of fracture of the scapular neck. All patients were performed clavicle fracture fixed, aeromial end of clavicle fracture fixed, acromioelavieular dislocation fixed, scapular neck fracture fixed, or both at the same time. Eight eases underwent reconstruction of the eoracoclavicular ligament with the use of autologous semitendinosus; 13 underwent directly suture repair of the acromioclavicular joint capsule and ligaments; 3 cases associated with acromial fractures underwent internal fixation. Results After a mean follow-up period of 23 months （12-72 months）, according to Herseovici scoring system, the shoulder functions were excellent in 21 cases （61.8%）, good in 9 （26.5%）, fair in 3 （8.8%）, and poor in 1 （2.9%）. Active shoulder flexion range exceeded 120° in 24 cases, 90°-120° in 8, fewer than 90° in 2 cases. After operation, five patients experienced shoulder stiffness, six shoulder pain. Conclusion The estimate of the stability of the SSSC was important to choose operation method of FSI. The restoration of the stability of the SSSC really affected the treatment outcome of FSI.