Scapula Fracture in a Child: Report of a Rare Injury

Scapular fracture is exceptional in children, mainly occurring after high-energy trauma. Radiologic investigations help its diagnosis and classification, which determines its management. We report the case of a 14-year-old patient admitted for blunt trauma of the left shoulder after falling from a speeding car. The diagnosis of a displaced fracture of the body of the scapula was made, and non-operative treatment was indicated and carried out for four weeks, followed by physiotherapy for another four weeks. Nine weeks after the trauma, the mobility of the affected shoulder was equivalent to that of the contralateral shoulder.

Osteotomy of the Margo Medialis Scapulae to Approach Subscapular and Subrhomboid Tumors. A Technical Note

Purpose: The approach to resect subscapular and subrhomboid tumors needs elevation of the scapula. This is usually performed by detaching the muscles from the margo medialis of the scapula. We wish to communicate our technique of a longitudinal osteotomy of the margo medialis for improved refixation of the muscles. Patients and Methods: 5 patients with subscapular and one patient with a subrhomboid benign tumor were operated on using this technique. Results: All patients achieved stable healing and full functional recovery;only in one patient there was slightly reduced elevation of the arm. Conclusion: Elevation of the muscles inserting into the medial scapular margo with a small rim of bone facilitates refixation and allows for excellent restitution of function.

Assessment of scapulohumeral rhythm for scapular plane shoulder elevation using a modified digital inclinometer

AIM: To develop a better understanding of scapulohumeral rhythm during scapular plane shoulder elevation.METHODS: Thirteen healthy, college-aged subjects participated in this study. Subjects were free from any upper extremity, neck or back pathology. A modified digital inclinometer was utilized to measure scapular upward rotation of the subject's dominant shoulder. Upward rotation was measured statically as subjects performed clinically relevant amounts of shoulder elevation in the scapular plane. Testing order was randomized by arm position. Scapular upward rotation was assessed over the entire arc of motion and over a series of increments. The percent contributions to shoulder elevation for the scapula and glenohumeral joint were calculated. Scapulohumeral rhythm was assessed and represented the ratio of glenohumeral motion to scapulothoracic motion(glenohumeral elevation: scapular upward rotation). A one-way ANOVA wasused to compare scapular upward rotation between elevation increments.RESULTS: Scapulohumeral rhythm for the entire arc of shoulder elevation was equal to a ratio of 2.34 :1 and ranged from 40.01:1 to 0.90:1 when assessed across the different increments of humeral elevation. Total scapular motion increased over the arc of shoulder elevation. The scapula contributed 2.53% of total motion for the first 30 degrees of shoulder elevation, between 20.87% and 37.53% for 30o-90 o of shoulder elevation, and 52.73% for 90o-120 o of shoulder elevation. Statistically significant differences in scapular upward rotation were identified across the shoulder elevation increments [F(3,48) = 12.63, P = 0.0001].CONCLUSION: Clinically, we must recognize the usefulness of the inclinometer in documenting the variable nature of scapulohumeral rhythm in healthy and injured shoulders.

Shoulder Reconstruction with Massive Scapular-Proximal Humerus Osteoarticular Allograft after Total Scapulectomy for Proximal Humerus Osteosarcoma Recurrence

Bone tumors are infrequent within the scapula. Total scapulectomy with massive allograft reconstruction represents an attractive alternative to amputation when the whole scapula is invaded with tumor and the neurovascular bundle can be preserved during tumor resection. We report a case of resection of the scapula and proximal humerus for recurrent osteosarcoma with massive allograft reconstruction of the scapula and proximal humerus. A 22-year-old male patient was seen in February 1992 for a pathological fracture of the proximal left humerus. In July 1992, a resection of the proximal end of the humerus followed by a reconstruction with osteochondral allograft and nail osteosynthesis was performed. The postoperative course was uneventful. In September 2009, 17 years later, the patient presented with a huge tumor developed at the level of the scapula. There was no vascular or neurological symptom. Plain radiography showed an expansive osteolytic mass. CT scan demonstrated scapular and proximal humerus invasion. An extended assessment revealed the presence of two pulmonary nodules. The biopsy confirmed the recurrence of osteosarcoma. The indication of a resection of both the left scapula and the 1992 allograft which was completely invaded at its proximal portion and the complete reconstruction of the scapula and the proximal humerus with allograft was made. One year postoperatively, we note a favourable outcome in terms of musculoskeletal functions. Despite two resection surgeries of pulmonary nodules and chemotherapy treatments, the patient developed new lung metastases and an unfavourable outcome. Although shoulder function was almost completely eliminated following surgery, preservation of elbow, wrist and finger motion resulted in an acceptable level of postoperative limb function. This reconstruction appears to be an attractive technique to be used in similar cases. The necessity of a reliable tissue bank with quality allografts in sufficient number is paramount.

Primary Alveolar Soft Part Sarcoma of the Scapula

Alveolar soft-part sarcoma (ASPS) is an uncommon, aggressive soft-tissue neoplasm, occurring in less than 1% of sarcomas. It is typically found in the head and neck tissues in children or in the deep soft tissues of the lower extremities in young adults. This tumor arises primarily within the skeletal muscles or musculofascial planes. Primary involvement of bone is extremely rare. ASPS has poor prognosis with a propensity for recurrence as well as distant metastasis. In this report, we present a 25-year-old male with primary ASPS in the left scapular bone and discuss the histopathological and immunohistochemical features of this sarcoma.

Fire-Needle Acupuncture Treatment in Scapular Muscle Fasciitis

The scapula (shoulder blade) is a large triangular-shaped bone located in the upper back and includes two muscles on each side. The scapula is surrounded and supported by a complex system of muscles that work together to help in the arm movement. If some condition or injury causes these muscles to become imbalanced or weak, the position of the scapula can be altered at rest or in motion. A change in the scapular positioning or motion can make difficulties in the arm movement, especially when performing overhead activities and may cause shoulder weakness. Acupuncture treatment as part of the Traditional Chinese Medicine is most commonly used treatment for treating musculoskeletal disorders. In the treatment of scapular muscle fasciitis the fire-needle acupuncture gave the fastest and best results in our practice. The aim of the treatment is to break up the scar tissue and the adhesions which commonly form at the site, to relax the levator scapula muscle and restore local normal blood and energy flow. In the research are included 13 patients, 6 male and 7 female, on age from 24 to 70. All patients had scapular pain and on all was performed fire-needle acupuncture. Most common age groups are 50 - 60, most patients have pain on the right scapula and most of them—9 have done only one treatment. A long-term problem with the scapula muscle can be resolved with only one fire-needle acupuncture treatment.

“E骨”-反肩置换术一站式术前规划系统

目的为提高反肩置换术术前规划的精准度和效率,本研究开发了“E骨”—反肩置换术一站式术前规划系统。方法利用nnU-net深度神经网络进行肩胛骨分割,获得精确的肩胛骨分割结果;结合骨密度、上下倾角和入钉长度3个关键因素自动定位基座,并计算出手术规划所需定量参数;结合关节盂形态和基座定位信息生成个性化导板;编写系统界面,将各部分功能模块化组装便于使用,提供交互操作与规划结果显示的功能。结果构建出“E骨”术前规划系统。本系统与Mimics系统相比,减少了规划过程中繁琐的手动调整,平均入钉长度规划结果长于Mimics系统,且规划时间缩短86%。本系统肩胛骨分割精度达到99.93%,较Mimics更高。结论本研究为反肩置换术提供了一套一站式的高效、精准的术前规划方案,具有广泛的临床应用前景。

基于经筋理论探讨“绕肩胛”与颈痛伴旋转功能障碍的对应关系

目的立足于经筋古籍原文,发现“绕肩胛”与手阳明、手太阳经筋相关,并从两条经筋与颈痛伴旋转功能障碍的联系入手,探讨“绕肩胛”相关经筋与颈痛伴旋转功能障碍是否存在对应关系。方法收集20例颈痛伴功能障碍的肩胛区域疼痛志愿者,对肩胛区8个阳性反应点进行触诊,根据疼痛部位以及颈部旋转功能障碍的类型,探索二者之间的对应规律。结果10例旋转伴后伸功能受限患者,在肩胛上区出现阳性反应点为9例,符合占比90%;10例旋转伴前屈功能受限患者,在肩胛下区出现阳性反应点为9例,符合占比90%。因而旋转伴后伸功能受限与肩胛上区、旋转伴前屈功能受限与肩胛下区存在对应关系。结论手阳明经筋与旋转伴后伸功能受限、手太阳经筋与旋转伴前屈功能受限存在对应关系。

A new cause of snapping scapula and its arthroscopic treatment

Snapping scapula is an uncommon condition described as palpable, audible, or painful crepitus of the scapula that causes diminished quality of life.l Until now it is still a largely under-recognized problem because of its diverse causes. The etiology of the problem is mainly divided into three major categories： bursitis, muscle abnormality, and bony or soft-tissue abnormality.

经肩袖肌间隙入路和Judet入路治疗肩胛骨骨折的疗效差异分析

目的研究肩胛骨骨折治疗行经Judet和肩袖肌间隙入路的疗效差异。方法便利选择徐州仁慈医院于2021年1月—2023年6月收治的78例肩胛骨骨折患者为研究对象,采用随机数表法分为两组,对照组行Judet入路(39例),观察组行肩袖肌间隙入路(39例)。比较两组手术指标、肩关节功能、肩胛骨恢复优良率及并发症。结果两组骨折愈合用时对比,差异无统计学意义(P>0.05);观察组术中出血量、切口长度、术后引流量、手术耗时、术后消肿用时均优于对照组,差异有统计学意义(P均<0.05)。观察组各项肩关节功能(疼痛、日常活动、肌力、肩关节活动度)评分高于对照组,差异有统计学意义(t=4.628、7.230、8.107、4.406,P均<0.05)。观察组肩胛骨恢复优良率(97.44%)高于对照组(79.49%),差异有统计学意义(χ^(2)=4.522,P<0.05)。观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论较Judet入路,经肩袖肌间隙入路治疗肩胛骨骨折切口更小,出血、引流更少,恢复更快,并发症更少,术后肩关节功能恢复更好,疗效更佳。

Cutaneous bronchogenic cyst in the left scapular region of a boy

Background:Scapular bronchogenic cyst(SBC)is rare.Methods:A sinus on a boy's left scapula was excised.Results:Histopathological analysis showed the epithelium with scattered PAS-positive goblet cells was positive for CEA and CK7.Conclusion:SBC should be suspected of a superfi cial scapular skin lesion in children.

Upper Pleistocene human scapula from Salawusu,Inner Mongolia,China

This article presents a fossil human scapula which was found in situ from the lower part of the Salawusu Formation in 1980 at the Salawusu site of Inner Mongolia,China. The stratum is dated from 70.9±6.2 ka BP to 124.9±15.8 ka BP by TL method. Dates from 44±7 ka BP to 63±3 ka BP, 61―68 ka BP and 35.34±2 ka BP are obtained for the lower part of this layer by 230Th, IRSL and 14C respectively. Based on the comparisons between this scapula and the scapulae of Neanderthals, Skhul/Qafzeh fossils, Eurasian Upper Paleolithic specimens and recent modern humans on the glenoid fossa, axillo-spinal angle, axillary border and other features, the present authors arrived at a preliminary conclusion that this Salawusu scapula is characterized by modern fea- tures of Upper Pleistocene humans mixed with a Neanderthal-like feature.

Winging of scapula due to serratus anterior tear

肩板的 Winging 由于对供应 serratus 的长胸的神经的损害最通常发生前面的肌肉。对 serratus 的创伤的损害前面的肌肉本身是很稀罕的。我们由于 serratus 的眼泪报导了肩板的创伤的 winging 的一个案例在 19 岁的男性的前面的肌肉。Winging 在中立位置并且在右肩膀关节然而并非在 wall&rdquo; 上的 &ldquo;push 上的扩展是在场的测试。病人保存地被管理并且完成了令人满意的结果。

肩胛骨孔洞的分类与形态学观测及其临床意义

背景:肩胛骨孔洞可影响临床上对肩胛骨及其周围解剖结构疾病诊断和治疗的临床决策。然而,肩胛骨孔洞缺乏分型,国人的肩胛骨孔洞分布及其形态计量研究等仍缺乏。目的:研究中国人群干燥肩胛骨孔洞的分类、分布和形态计量学,探讨其临床意义。方法:定义了一个新的肩胛骨孔洞分类系统,包括3个类别和A-F等6个亚型。Ⅰ类对应于肩胛骨的神经和血管孔,Ⅱ类对应于肩胛骨的非神经血管孔洞,Ⅲ类为Ⅰ类和Ⅱ类的混合型。Ⅰ类包括2种类型:A型为肩胛上孔,B型为营养血管孔;Ⅱ类分C-E亚型;Ⅲ类仅包括F型(即为A-E的混合型)。同时分析统计了336个非配对干燥国人肩胛骨的分类、分布和形态计量学数据。结果与结论:(1)观察者间的信度优秀。在336个肩胛骨中,共观察到92个肩胛骨上分布118个肩胛骨孔洞,肩胛骨孔洞发生率为27.38%,其中Ⅰ、Ⅱ、Ⅲ类分别占2.81%,16.96%和7.61%,A-F型肩胛骨孔洞占比分别为7.61%,19.57%,9.78%,10.87%,40.22%和11.96%,E型最多;(2)A-F型肩胛骨孔洞总直径分别为(8.09±1.29),(1.98±0.80),(6.60±3.10),(11.19±6.67),(16.80±11.04)和(17.43±13.88)mm,F型总直径最大;A-F型肩胛骨孔洞总面积分别为(37.62±19.48),(2.13±2.23),(32.52±24.85),(77.56±124.32),(150.69±181.34)和(109.98±193.50)mm~2,E型总面积最大;(3)结果表明,肩胛骨孔洞的变异是常见的,需要临床医生注意,以避免因肩胛骨孔洞的出现而对诊断产生干扰,同时治疗时需要加以关注,避免侵入性操作时引起并发症。

桥接组合式内固定系统治疗肩胛骨骨折的临床效果

目的:分析桥接组合式内固定系统(BCFS)治疗肩胛骨骨折的临床疗效。方法:选取2017年5月—2022年12月于常州市第四人民医院骨科进行手术治疗的肩胛骨骨折患者40例作为研究对象,随机分为试验组和对照组,各20例。试验组接受BCFS手术,对照组接受常规重建钢板内固定手术,比较两组感染发生率、骨折复位,手术时间、出血量引流量,肩关节功能评分,骨折愈合时间、术后3个月预后情况。结果:两组切口均一期愈合,无感染发生;试验组骨折复位情况优于对照组,差异有统计学意义(P<0.05)。试验组手术时间短于对照组,术中出血量及术后引流量少于对照组,差异有统计学意义(P<0.05)。术后1、3个月,试验组Constant-Murley评分高于对照组,差异有统计学意义(P<0.001)。试验组骨折愈合时间短于对照组,差异有统计学意义(P<0.001)。对照组中1例患者于术后2个月再次外伤后,引发内固定物断裂,两组其他患者影像学检查均未出现继发性骨折移位及内固定失效,差异无统计学意义(P=0.311)。结论:肩胛骨骨折患者选择BCFS手术可以有效提高手术效果,在手术时间、术中及术后出血量、改善关节功能等方面具有明显的优势。

腋后路内固定治疗IdebergⅠa及Ⅱ型肩胛盂骨折的疗效分析

目的:探讨腋后路治疗IdebergⅠa及Ⅱ型肩胛盂骨折的疗效。方法:回顾性分析2018年12月至2021年9月采用腋后路治疗的9例肩胛盂下部分骨折患者的资料,男3例,女6例;年龄50~78岁。所有患者骨折为闭合性骨折,依据肩胛盂骨折Ideberg分型:Ⅰa型6例,Ⅱ型3例。分别于术后第6、12周及6、12个月摄肩关节正、侧位X线片,记录所有患者末次随访时的Constant-Murley肩关节评分,上肢功能障碍(disability of the arm,shoulder and hand,DASH)评分,骨折愈合情况以及其他并发症情况。结果:术后9例患者获得随访,时间6~15个月。末次随访时9例均获得骨性愈合,愈合时间3~6个月,末次随访时患者的Constant-Murley评分为55~96分;DASH评分为3.33~33.33分。结论:腋后路内固定治疗IdebergⅠa、Ⅱ型肩胛盂骨折有效解决了前方入路显露肩胛盂下部分骨折困难的问题,可避免肩胛下肌以及关节囊医源性损伤,临床效果满意,值得临床推广使用。

利用肩部CT图像和后处理技术优化的肩胛骨受限侧位X线摄影体位

目的借助肩部CT图像和图像后处理技术优化肩胛骨骨折等体位受限患者肩胛骨侧位X线摄影体位。方法回顾性分析580例肩部CT平扫病例影像,借助肩胛骨的容积重组(volume reformation,VR)与最大密度投影(maximum intensity projection,MIP)图像找出肩胛骨侧位显示最佳的位置、测出其相较于标准后前位时绕躯体的旋转角度值,并对性别和年龄段与该角度测量值的关系进行分析,设计出针对体位受限患者的肩胛骨侧位X线成像体位,并以临床实践进行验证。结果体位受限患者最佳的肩胛骨侧位体位设计为患者面向探测器,患侧贴近探测器并使身体正中冠状面与探测器成约(59.70±6.26)°夹角;年龄段和性别对该角度的测量值均无影响,各组间差异均无统计学意义(P>0.05);临床实践显示该体位具有较好的应用效果,肩胛骨侧位均能得到较好的显示。结论肩部CT图像和图像后处理技术可用于肩胛骨骨折等体位受限患者的肩胛骨侧位X线检查体位的优化,使摄取的肩胛骨侧位平片影像质量得到保证。

肩峰下撞击综合征的康复治疗进展

肩峰下撞击综合征(SIS)是临床常见的肩部疾患,以疼痛和运动功能障碍为主要特征,严重影响患者的日常活动能力及生活质量。肩胛骨作为肩关节复合体中重要的组成部分,在肩关节的运动链中起到近端稳定的作用,并与盂肱关节进行协调运动。肩袖肌群能够保证肱骨头在肩关节运动时的动态稳定性。康复治疗是SIS的保守治疗方法之一,其通过肩袖肌群的强化训练、肩胛骨稳定性训练、手法治疗及物理因子治疗等,能够减轻SIS患者的肩部疼痛,并改善肩关节的运动功能。目前,针对SIS的研究采用的治疗方案各不相同,治疗效果也存在差异。未来需对SIS的康复时机、手段及强度进行深入研究,以为SIS的早期干预和术后康复提供参考。

三维CT重建肩胛下肌损伤的相关因素及预测效能评估

背景:肩胛下肌作为肩袖肌群中最大且唯一的前肩袖肌,其损伤时常被忽视,且肩胛下肌局部损伤仍具有诊断难度,近年来有研究发现喙肱距及喙突过度覆盖距离可作为肩胛下肌损伤的预测因子。目的:探究喙肱距离、喙突过度覆盖距离及患者双侧肩关节喙肱距差异与肩胛下肌损伤的关系,评估各参数对肩胛下肌损伤的诊断效能。方法:回顾性收集2021年2月至2022年6月退变性肩袖损伤患者的术前临床及影像学资料,根据术中关节镜检查结果将患者分为肩袖损伤合并肩胛下肌撕裂组(肩胛下肌撕裂组,28例),肩袖损伤不伴有肩胛下肌撕裂组(对照组,56例)。将入组患者的CT资料以DICOM格式导入Mimics软件,重建患者肩胛骨及肱骨近端,确定测量点建立测量平面,在3-matic软件测量患者喙肱距离、喙突过度覆盖距离。比较两组患者组间参数差异及组内双侧差异,并对各参数进行受试者工作特征曲线分析,确定各参数曲线下面积及最佳截断值。结果与结论:(1)组间比较喙肱距离:肩胛下肌撕裂组为(7.00±0.87) mm,对照组为(9.08±1.02) mm,肩胛下肌撕裂组明显小于对照组(P <0.01);组间比较喙突过度覆盖距离:肩胛下肌撕裂组为(21.05±1.98) mm,对照组为(19.46±1.55) mm,肩胛下肌撕裂组明显大于对照组(P <0.01);(2)组内比较双侧喙肱距差异:肩胛下肌撕裂组患侧喙肱距离(7.00±0.87)mm明显小于健侧(9.26±0.87)mm,差异有显著性意义(P<0.01);(3)受试者工作特征曲线分析:喙肱距离、喙突过度覆盖距离、双侧喙肱距差异的曲线下面积(AUC)分别为0.884,0.729,0.905;最佳截断值分别为7.65,20.2,1.15 mm;(4)结果表明,喙肱距离、喙突过度覆盖距离、双侧喙肱距差异均与肩胛下肌损伤有关,均可作为肩胛下肌损伤的预测因子,其中双侧喙肱距差异的预测效能最高,3个测量参数在临床术前诊断可提供一定参考价值。