肩胛颈骨折的分类和手术治疗

Classification and surgical treatment of scapular neck fractures

目的探讨肩胛颈骨折的分类及手术治疗。方法对2000年1月-2007年12月收治的18例肩胛颈骨折进行回顾分析。男12例，女6例；年龄17～62岁，平均41岁。全部行CT检查。根据Hardegger分型，解剖颈骨折10例，外科颈骨折8例；按照Miller分型，ⅡA5例，ⅡB6例，ⅡC6例，ⅡB＋ⅡC 1例。15例有合并损伤。手术入路为后外侧入路9例，改良Judet入路6例，前后联合入路3例，应用重建钢板和拉力螺钉固定骨折。结果全部患者随访6～70个月，平均25．5个月。根据Constant—MuAey评分评价疗效，平均73分（35～95，中位数75．5）。并发复位不良2例，肩关节不稳定1例，创伤性关节炎3例。结论肩胛颈骨折成角畸形孟极角〈20°、骨折移位≥10mm、合并浮肩损伤或肩关节上方悬吊复合体损伤时，应早期手术治疗。预后影响因素主要为合并损伤、复位质量、固定坚强程度、肩袖损伤及术后康复等。

Objective To explore the classification and surgical treatment of scapular neck fractures. Methods A retrospective analysis was done based on the clinical data of 18 patients （including 12 males and 6 females） who accepted operation in Tianjin Hospital from January 2000 to December 2007. The average age of the patients was 41 years （ 17-62 years）. All patients accepted CT examination. According to Hardegger classification, there were 10 patients with anatomical neck fractures and eight with surgical neck fractures. According to Miller system, there were five patients with type Ⅱ A fractures, six with type ⅡB fractures, six with type ⅡC fractures and one with type Ⅱ B ＋ ⅡC fracture. Of all, 15 patients had associated injury. The operative approach included posterolatera[ approach in nine patients, modified Judet approach in six and anteroposterior conjoint approach in three. Reconstruction plates and lag screws were applied to fix the fractures. Results All patients were followed up consecutively with an average period of 25.5 months （6-70 months）. The mean Constant-Murley score was 73 points （35-95 points, meadian 75.5 points） after treatment. There were two patients with malreduction, one with shoulder instability and three with traumatic arthritis postoperatively. Conclusions The indications for early operation include ： （ 1 ） angular deformity in horizontal or coronal planes of fractures,ie, glenopolar angle （GPA） 〈20° /2） fracture displacement ≥10 mm; （3） associated with floating shoulder injury or superior suspensory shoulder complex injury. The major factors influencing prognosis are associated injuries, quality of fractures reduction, fixation stability, injury of rotator cuff and postoperative rehabilitation.