肩关节上部悬吊复合体双重损伤的治疗

Treatment of double injuries of superior shoulder suspensory complex

目的:探讨肩关节上部悬吊复合体双重损伤手术治疗方法。方法:自2008年1月至2010年3月收治该类损伤11例,男9例,女2例;年龄20～47岁,平均38岁。分4类治疗:肩胛颈骨折合并同侧锁骨骨折4例,分别用重建钢板固定;喙突骨折或喙锁韧带断裂加锁骨肩峰端骨折或肩锁关节脱位2例,锁骨肩峰端骨折或肩锁关节脱位锁骨钩钢板固定,空心加压螺钉固定喙突骨折;肩峰基底部加肩胛盂加肩锁关节(锁骨外侧端骨折)损伤3例,肩峰基底部骨折切开复位重建钢板内固定,锁骨钩钢板固定肩锁关节(锁骨外侧端骨折);肩峰加肩锁关节加锁骨外侧1/3骨折2例,肩峰用小斜"T"形钢板固定,肩锁关节、锁骨外侧1/3骨折用锁骨钩钢板固定。采用Constant-Murley评分评价肩关节功能。结果:本组11例中9例获随访,时间6～12个月,平均9.2个月。所有骨折愈合,无内固定失效和骨折不愈合。骨折平均愈合时间2.6个月,肩关节外形正常,双肩对称,无肩关节短缩、下垂、内收内旋等严重肩下垂畸形。根据Constant-Murley评分,本组评分为69～100分,平均89.7分,其中疼痛评分10～15分,日常活动评分14～20分,肌力评分15～25分,活动范围评分34～40分。结论:肩关节上部悬吊复合体双重损伤需手术分型治疗恢复其完整性和稳定性。

Objective：To explore operative method for the treatment of double injuries of superior shoulder suspensory complex（SSSC）.Methods：From January 2008 to March 2010,11 patients wiht SSSC injuries were treated,including 9 males and 2 females with an average age of 38 years（ranged from 20 to 47 years）.The patients were treated with 4 methods as follows：4 patients with fractures of neck of scapula combined with homolateral fracture of clavicle were treated with reconstituted plates;2 patients with fractures of coracoid process or disruption of coracoclavicular ligament combined with the fracture of extremitas acromialis claviculae or acromioclavicular dislocation were treated with clavicular hook plates and cannulated compression screws;3 patients with injuries of basilar part of acromial process combined with the glenoid cavity and acromioclavicular articulation were treated with reconstuction plates and clavicular hook plates;2 patients with fractures of acromial process combined with acromioclavicular dislocation and the fracture of lateral third of clavicle were treated with small ＂T＂ plates and clavicular hook plates.Results：Among 11 patients,9 patients were followed up with an average duration of 9.2 months （ranged from 6 to 12 months）.All the fractures were healed without bone nonunion or failure of internal fixators.The average union time was 2.6 months.The profile of articulatio capitis humeri was normal and hibateral articulatio capitis humeri was symmetrical without crispation,descensus,adduct and adtorsion of articulatio capitis humeri or other abnormity.According to the Constant-Murley evaluation system,the score ranged from 69 to 100,with an average of 89.7,which included average pain score of 10 to 15,daily activities score of 14 to 20,myodynamia score of 15 to 25,territory score of 34 to 40.Conclusion：The double injuries of SSSC should be treated by types to recover the integrity and constancy of SSSC.