重建接骨板治疗肩胛骨颈部及体部骨折的近期临床疗效分析

Short-term clinical outcome of reconstruction plate fixation for neck and body fractures of scapular

背景：肩胛骨骨折发生率逐年增高，对于移位较大的肩胛骨骨折，保守治疗往往存在骨折畸形愈合、肩周疼痛等问题。目的：探讨重建接骨板固定肩胛骨骨折的手术方式及临床疗效。方法：2011年8月至2014年9月共收治肩胛骨骨折患者34例，男28例，女6例；年龄24-67岁，平均（36.4±5.4）岁。按肩胛骨骨折Hardegger分型：肩胛体骨折27处，肩胛颈骨折15处，肩峰骨折1处，肩胛骨骨折4处，盂缘骨折2处，喙突骨折1处，盂窝骨折1处。术前Constant肩关节评分为12.0-25.6分，平均（18.7±6.4）分。受伤至手术时间为3-11 d，平均（6.4±1.1）d。记录患者并发症发生情况及末次随访Constant肩关节评分。结果：34例患者术后获11-17个月随访，平均（12.4±1.2）个月。骨折愈合时间为7-12周，平均（8.0±0.7）周，无伤口感染及愈合不良，无内固定断裂、松动、骨折不愈合及神经血管损伤等并发症发生。按照Constant肩关节评分标准评价患肩功能较术前显著改善，Constant评分为78.5-95.0分，平均（89.0±3.2）分（P＜0.05）。结论：重建接骨板治疗肩胛骨颈部及体部骨折可以获得良好复位，术后近期期肩关节功能良好。

Background：The incidence of the scapular fracture has been increased year by year. Conservative treatment of-ten results in malunion and shoulder pain for large injury. Objective：To discuss the operation method and clinical outcomes of reconstruction plate fixation for scapular fracture. Methods：From August 2011 to September 2014, 34 patients with scap-ular fractures were treated. There were 28 males and 6 females with an average age of （36.4±5.4） years （range, 24-67 years）. According to the Hardegger classification：scapular body fracture in 27 cases, scapular neck fracture in 15, acromion frac-ture in 1, spine of scapula fracture in 4, glenoid rim fracture in 2, fracture of coracoid process in 1, and glenoid fossa frac-ture in 1. Preoperative Constant shoulder score was 18.7 ± 6.4 （range, 12.0-25.6）. The mean period from injury to surgery was （6.4 ± 1.1） d （range, 3-11 d）. The incidence of complications and the Constant shoulder score were recorded at the last follow-up. Results：All the 34 patients were followed up for （12.4±1.2） months on average （range, 11-17 months）. The mean healing time was （8.0±0.7） weeks （range, 7-12 weeks）. No wound infection, poor healing, broken internal fixation, loosen-ing, nonunion or nerve-vascular injuries occurred. Shoulder function was obviously improved according to the results of Constant shoulder score, and the mean Constant score was 89.0±3.2 （range, 78.5-95.0, P〈0.05）. Conclusions：Scapular neck and body fractures treated with the reconstruction plate fixation can obtain good reduction and good short-termfunction of the shoulder joint.