Fischer P J, Kent R B
The Trauma Center at Carraway, Carraway Methodist Medical Center, Birmingham, Ala, USA.
South Med J. 2001 Apr;94(4):383-6.
Scapulothoracic dissociation refers to the traumatic separation of the shoulder from the chest wall. This most commonly occurs as a closed injury. We present a case of open scapulothoracic dissociation and emphasize clinical features unique to this injury. In both closed and open scapulothoracic dissociation, the force necessary to shear the scapula from its thoracic attachments results in vascular disruption and neurologic injury to the upper extremity. As a consequence, patients have a pulseless, flail upper extremity with a significant chest wall hematoma (closed) or active bleeding (open). The first priority is to resuscitate and address life-threatening injuries. If the patient has active bleeding, immediate vascular control to prevent exsanguination is essential. Patients with ischemia and an incomplete injury or unreliable neurologic examination need revascularization. Outcome is based on the extent of brachial plexus or cervical nerve root avulsion. Patients with loss of neurologic function ultimately benefit from amputation at the appropriate level.
肩胛胸壁分离是指肩部与胸壁的创伤性分离。这种情况最常发生为闭合性损伤。我们报告一例开放性肩胛胸壁分离病例，并强调该损伤独特的临床特征。在闭合性和开放性肩胛胸壁分离中，将肩胛骨从其胸廓附着处剪切所需的力量会导致血管破裂和上肢神经损伤。因此，患者会出现无脉、连枷样上肢，并伴有明显的胸壁血肿（闭合性）或活动性出血（开放性）。首要任务是进行复苏并处理危及生命的损伤。如果患者有活动性出血，立即控制血管以防止失血至关重要。存在缺血且损伤不完全或神经检查结果不可靠的患者需要进行血管重建。预后取决于臂丛神经或颈神经根撕脱的程度。神经功能丧失的患者最终在适当水平截肢会受益。
