合并肩锁关节脱位的喙突骨折新分型

Clinical significance for new type of coracoid process fractures associated with acromioclavicular dislocation on CT three-dimensional reconstruction

目的:观察喙突骨折合并肩锁关节脱位在CT影像上的表现形式,进行分类总结,探讨合并肩锁关节脱位的喙突骨折新分型。方法:回顾分析2012年5月至2021年6月使用锁骨钩钢板固定治疗喙突骨折合并肩锁关节脱位具有完整影像资料的患者,排除合并同侧上肢其他部位骨折或脱位,影响治疗及预后,或既往存在患侧肩关节慢性疾病,影响肩关节功能者。纳入18例,其中男10例,女8例,受伤时年龄16~54岁。受伤原因:摔伤15例,车祸伤2例,高处坠落伤1例。受伤至手术时间为1~7 d。在CT三维重建影像上观察喙突骨折形态及其与肩胛骨的对应关系,观察喙突骨折复位情况,根据不同表现形式及转归进行分类。结果:共纳入18例18肩,在CT三维重建影像上观察到喙突骨折合并肩锁关节脱位病例的3种喙突骨折表现形式,分别是Ⅰ型(撕脱骨折,喙突形态大体保持完整)1例,喙突骨折未能间接复位;Ⅱ型(铰链式骨折,喙突骨折的一侧保持与肩胛骨连接,或者移位程度小于骨折的另一侧)15例,在肩锁关节复位固定后,喙突骨折均间接复位,其中7例喙突骨折解剖复位;Ⅲ型(平移骨折,喙突骨折断面大致呈平行)2例,喙突未能复位。结论:根据喙突骨折在影像上的表现形式建立CT三维分型,充分考虑喙突骨折合并肩锁关节脱位的损伤累及情况,更能反映疾病的本质,为临床诊断、治疗和预后判断提供参考。结合喙突骨折复位率,初步提出喙突骨折合并肩锁关节脱位,单纯固定肩锁关节是可行的,效果满意,喙突骨折无需外科干预。

Objective To observe the computerized tomography(CT)imaging manifestations of coracoid process fractures associated with acromioclavicular(AC)joint dislocation and make classification and summary,and explore a new classification of coracoid process fracture combined with acromioclavicular joint dislocation.Methods The medical records of patients with the acute traumatic coracoid process fractures associated with AC joint dislocation who had undergone surgical management with clavicular hook plate fixation between May 2012 and June 2021 were retrospectively reviewed.Patients with fractures or dislocations of other parts of the ipsilateral upper limb,which affect the treatment and prognosis,or with chronic shoulder diseases on the affected side,which affect the function of the shoulder joint,were excluded.Eighteen patients were enrolled,including 10 males and 8 females,aged from 16 to 54 years old at the time of injury.The causes of injury were fall in 15 cases,traffic accident in 2 cases,and high fall in 1 case.The time from injury to operation ranged from 1 to 7 days.The morphology of coracoid process fracture and its corresponding relationship with scapula were observed on CT three-dimensional reconstruction images,and the reduction of coracoid process fracture was observed.The results were classified according to different manifestations and outcomes.Results A total of 18 patients with 18 shoulders were included according to the Inclusion and exclusion criteria.Three manifestations of coracoid process fracture associated with acromioclavicular joint dislocation were observed on CT three-dimensional reconstruction images.One case was typeⅠ(avulsion fracture,coracoid process shape remained general intact),and the coracoid process fracture failed to self-reduction after AC joint reduction and fixation;Fifteen patients with typeⅡ(hinged fracture,in which one side of the coracoid process fracture remained attached to the scapula or was less displaced than the other side of the fracture)had spontaneous reduction after AC joint reduction and fixation,even 7 of them had coracoid process fracture anatomical reduction;In 2 cases of typeⅢ(translational fracture,coracoid process fracture with approximately parallel profile),coracoid process fracture failed to self-reduce after AC joint reduction and fixation.Conclusion The new type of coracoid process fractures associated with acromioclavicular dislocation on CT three-dimensional reconstruction provides an overview of the injury involvement of coracoid process fracture associated with AC joint dislocation,better understand of the nature of the disease,and a reference for clinical diagnosis,treatment and prognosis to the surgeon.Based on the fact that most coracoid fractures especially hinged fractures have spontaneous reduction after AC joint reduction and fixation,we believe that simple fixation of the AC joint is feasible and satisfactory for coracoid process fractures with acromioclavicular joint dislocation,and no surgical intervention is required for coracoid process fractures.