肩峰骨折的分型方法及治疗

The acromion fracture： classification and treatment

目的 探讨肩峰骨折的分型方法及治疗.方法 自2006年8月至2008年8月共收治14例肩峰骨折患者,男11例,女3例;年龄17～65岁,平均49.4岁.肩峰骨折按照Ogawa分型：Ⅰ型3例,Ⅱ型7例,Ⅲ型4例.有5例肩峰骨折属于上肩胛悬吊带复合损伤一部分,其中复合损伤属于肩峰-肩锁关节-锁骨远端3例,锁骨中段-肩峰-肩胛骨外科颈1例,锁骨-喙突-肩胛盂上1/3和肩峰基底部三部位联合损伤1例.共8例患者接受手术治疗,其中肩峰骨折接受手术治疗5例：空心拉力螺钉固定Ⅰ型1例,3.5 mm斜T型锁定接骨板固定Ⅱ型3例,锁定重建接骨板固定Ⅲ型1例.结果 手术组8例,平均随访13.8个月（12～18个月）.接受手术患者的肩峰骨折均获得解剖复位,骨性愈合,无内固定物松动等并发症发生,末次随访Constant评分平均84.7分.保守治疗组6例,平均随访15.5个月（14～18个月）,肩峰骨折均获骨性愈合,末次随访Constant评分平均71.7分.结论 通过对孤立性的移位明显的肩峰骨折或肩峰骨折属于上肩胛悬吊带多重损伤一部分进行手术治疗可以取得良好疗效.Ogawa分型结合上肩胛悬吊带复合体损伤理论能指导肩峰骨折的治疗,实用性强.

Objective To discuses the classification and treatment of the acromion fracture.Methods From August 2006 to August 2008, 14 patients with the acromion fracture were treate in our department. They were 11 males and 3 females, with an average age of 49. 4 （range, 17 to 65） years old.According to the Ogawa classification, 3 cases were Type Ⅰ, 7 cases Type Ⅱ and 4 cases Type Ⅲ. By injury type, 5 cases belonged to the double disruption of the superior shoulder suspensory complex. Eight patients had surgery and 5 displaced acromial fractures received open reduction and internal fixation through different surgical approaches according to the fracture type which was confirmed by preoperative 3D CT images.Results All the patients received a follow-up of more than one year. The acromial fractures in the surgical group were healed in their anatomical position with a mean Constant score of 84. 7 （range, 50 to 100） at the last follow up. The acromial fractures in the conservative group united with a mean Constant score of 71.7.The Constant score was higher for the un-displaced acromial fractures and lower for the malunited fractures.Conclusions Surgical treatment should be applied to the isolated and displaced acromion fracture or the fracture complicated with the double disruption of the superior shoulder suspensory complex. The Ogawa classification plus injury type may be a helpful guide in the treatment of rare acromial fractures.