Krishnan Sumant G, Hawkins Richard J, Michelotti John D, Litchfield Robert, Willis R Baxter, Kim Young Kyu
Department of Shoulder Service, W. B. Carrell Memorial Clinic, Dallas, TX, USA.
Clin Orthop Relat Res. 2005 Jun(435):126-33.
Twenty-two patients (24 shoulders) had a scapulothoracic arthrodesis for various clinical disorders including facioscapulohumeral muscular dystrophy, scapular winging from serratus anterior palsy, painful scapular crepitation, and cleidocranial dysostosis. All patients were extremely disabled with pain and loss of function because of their symptomatic scapular winging, and many of the patients had multiple previous procedures on their shoulders before the scapulothoracic arthrodesis. The surgical indication was stabilization of painful scapulothoracic articulation to provide pain relief and allow functional use of the involved arm for activities of daily living. The surgical technique involved use of a semitubular plate and wire construct along the medial border of the scapula with the use of autograft (iliac crest) or allograft bone or both between the scapula and the rib cage. Patients were immobilized postoperatively for 12 weeks. Complications occurred in more than (1/2) of the patients and included pulmonary complications, hardware failure, pseudarthrosis, and persistent pain. Postoperatively, 20 of 22 (91%) patients thought that the pain in their shoulder complex was improved and were satisfied with their functional outcome. Scapulothoracic arthrodesis can improve function and reduce pain in the shoulder complex in patients with debilitating complex scapulothoracic dysfunction. However, the high incidence of complications with this procedure is a concern.
Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.
22例患者（24个肩关节）因各种临床疾病接受了肩胛胸壁关节融合术，这些疾病包括面肩肱型肌营养不良、前锯肌麻痹所致的肩胛翼状肩、疼痛性肩胛摩擦音以及锁骨颅骨发育不全。所有患者因有症状的肩胛翼状肩而极度残疾，伴有疼痛和功能丧失，许多患者在肩胛胸壁关节融合术前肩部曾接受过多次手术。手术指征是稳定疼痛的肩胛胸壁关节，以缓解疼痛并使患侧手臂能够用于日常生活活动。手术技术包括沿肩胛骨内侧缘使用半管状钢板和钢丝结构，并在肩胛骨与胸廓之间使用自体骨移植（髂嵴）或同种异体骨或两者同时使用。患者术后固定12周。超过半数的患者出现并发症，包括肺部并发症、内固定失败、假关节形成和持续疼痛。术后，22例患者中有20例（91%）认为其肩部复合体的疼痛得到改善，并对其功能结果感到满意。肩胛胸壁关节融合术可改善肩胛胸壁功能严重受损患者肩部复合体的功能并减轻疼痛。然而，该手术并发症的高发生率令人担忧。
治疗性研究，IV级（病例系列——无或历史对照组）。有关证据水平的完整描述，请参阅作者指南。
