关节镜下撬拨复位治疗移位性肩胛颈骨折疗效观察

POKING REDUCTION TREATMENT OF DISPLACED SCAPULAR NECK FRACTURE WITH SHOULDER ARTHROSCOPY-ASSISTED SURGERY

目的探讨关节镜下撬拨复位治疗移位性肩胛颈骨折的疗效。方法 2009年1月-2012年1月,对9例移位性肩胛颈骨折采用关节镜下撬拨复位空心螺钉内固定治疗。其中男6例,女3例;年龄21-54岁,平均39岁。致伤原因：交通事故伤7例,高处坠落伤1例,钝物撞伤1例。患肩外展、前屈及外旋均明显受限。X线片检查明确肩胛颈部骨折,CT三维重建示骨折块明显移位。受伤至手术时间4-27 d,平均11 d。结果术后切口均Ⅰ期愈合,无感染及血管、神经损伤等手术相关并发症发生。9例均获随访,随访时间19-31个月,平均23个月。X线片复查示,肩胛颈骨折均愈合,愈合时间7~11周,平均8周。末次随访时,肩关节外展、前屈、外旋活动度均较术前显著改善（P〈0.05）,肩关节Constant评分、美国肩肘外科协会（ASES）评分和Rowe评分均优于术前（P〈0.05）。结论采用关节镜辅助下撬拨复位治疗移位性肩胛颈骨折,可重建肩关节稳定性,关节功能恢复较好,并发症较少。

Objective To discuss the ef ectiveness of Poking reduction with shoulder arthroscopy-assisted surgery for displaced scapular neck fracture. Methods Between January 2009 and January 2012, 9 cases of displaced scapular neck fracture underwent shoulder arthroscopy-assisted surgery for Poking reduction treatment. Of 9 cases, 6 were men, and 3 were women, aged 21-54 years（mean, 39 years）. The causes were trai c accident injury in 7 cases, falling injury from height in 1 case, and hurt injury in 1 case. The shoulder abduction, l exion, and external rotation were obviously limited. X-ray i lms showed all cases had obvious displaced scapular neck fracture. Three-dimensional reconstruction of CT showed a grossly displaced of fracture. The time of injury to surgery was 4-27 days（mean, 11 days）. Results Patients obtained healing of incision by i rst intension, without infection, neurovascular injury, or other surgery-related complications. All patients were followed up 19-31 months（mean, 23 months）. X-ray i lms showed scapular neck fractures healed from 7 to 11 weeks（mean, 8 weeks）. At last follow-up, the shoulder abduction, l exion, and external rotation activity were improved signii cantly when compared with ones at preoperation（P〈0.05）; the shoulder Constant score, American Shoulder and Elbow Surgenos（ASES） score, and Rowe score were signii cantly better than preoperative scores（P〈0.05）. Conclusion The reduction of displaced scapular neck fracture is necessary, and arthroscopic Poking reduction and i xation for displaced scapular neck fracture can reconstruct the shoulder stability and reduce complications.