【摘要】 目的:分析肩胛骨骨折的类型和手术治疗方法、效果,为类似病例提供参考。方法:回顾性分析本院2009年4月-2014年3月58例肩胛骨骨折患者的治疗情况,其中41例患者根据骨折类型采用个性化的手术治疗,设为手术组,17例保守治疗的患者设为非手术组,采用Hardegger功能评定评价疗效。所有患者均随访9~36个月,记录有无骨折移位、断钉、钢板断裂等手术并发症和非手术治疗相关并发症。结果:根据骨折与肩盂位置、肩关节整体的稳定性采用AO分类法,手术组关节内骨折、关节外骨折稳定骨折和不稳定骨折的构成比例分别为26.83%、34.15%、39.02%;根据骨折部位的Hardegger分型,手术组肩胛骨体部骨折、盂缘骨折、外科颈骨折、盂窝骨折、肩胛冈骨折、肩峰骨折、喙突骨折、粉碎性骨的构成比例分别为39.02%、19.51%、9.76%、7.32%、9.76%、7.32%、2.44%、4.88%;Milleretal分型手术组共骨折73处,Ⅰ、Ⅱ、Ⅲ、Ⅳ型构成比例分别为28.77%、28.77%、16.44%和26.03%;3种骨折分类方法手术组均与非手术组比较差异无统计学意义(P>0.05)。手术组41例患者治疗后,根据末次随访评价疗效,手术组平均肌力高于非手术组,关节活动度评分和疼痛评分均低于非手术组非手术组(P<0.05)。手术组优秀率为48.78%,优良率为85.37%,疗效明显好于非手术组(P<0.05)。手术组41例患者中出现关节外展受限、关节炎等并发症13例,并发症发生率为31.71%,明显低于对照组(P<0.05)。结论:肩胛骨骨折类型复杂,手术治疗具有功能恢复快,恢复效果好,并发症少的优点。只要术前通过相关检查准确分类并制定个性化手术方案,术中精细操作可获得满意的疗效。更多还原

【Abstract】 Objective: To summarize on the types,surgical treatment,and patient outcomes of scapular fractures,so as to provide a reference for patients with similar condition. Methods: This was a retrospective analysis of 58 scapular fracture patients in our hospital between April 2009 and March 2014. The surgical group consisted of 41 patients who received personalized surgery according to the type of fracture. The non-surgical group consisted of 17 patients who received conservative treatment. Hardegger classification was used for functional evaluation. All patients were followed up for 9-36 months,and recorded for re-displacement,screw breakage,plate rupture and other surgical or non-surgical treatment-related complications. Results: By AO classification according to the location of fracture to the glenoid and the overall stability of the shoulder joint,intra-articular fracture,stable extra-articular fracture and unstable extra-articular fracture accounted for 26. 83%,34. 15% and 39. 02%,respectively of patients in the surgical group. By Hardegger classification according to the site of fracture,scapular body fractures,glenoid rim fracture,surgical neck fractures,glenoid fossa fractures,scapular spine fractures,acromion fractures,and comminuted fracture of coracoid process accounted for 39. 02%,19. 51 %,9. 76%,7. 32%,9. 76%,7. 32%,2. 44% and 4. 88%,respectively,of patients in the surgical group.By Miller’s classification,there were 73 sites of fractures,with types I,Ⅱ,Ⅲ and IV fractures accounting for 28.77%,28. 77%,16. 44% and 26. 03%,respectively,of patients in the surgical group. The three systems of fracture classification did not yield significant difference between surgical and non-surgical groups(P > 0. 05).After treatment,the 41 patients in the surgical group showed higher muscle strength,lower joint motion scores and pain scores than the non-surgical group,as evaluated in the last follow-up(P < 0. 05). The efficacy was excellent in 48. 78%,or good in 85. 37%,of patients in the surgical group,which was significantly better compared with the non-surgical group(P < 0. 05). Of the 41 patients in the surgical group,13 experienced joint abduction,arthritis or other complications,corresponding to a complication rate of 31. 71% which was significantly lower compared with the control group(P < 0. 05). Conclusion: Scapular fracture is complicated by types. Advantages of surgery include quick,excellent recovery,and fewer complications. Accurate classification and pre-surgical planning for personalized options through proper examinations,along with dedicate intraoperative manipulations,may lead to satisfactory outcomes.更多还原