Ding Xianjun, Fan Shunwu, Zhang Jian
Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou Zhejiang, 310016, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2005 Jun;19(6):446-9.
To explore the effective method for treatment of fractures of scapular neck.
A retrospective analysis of 30 patients with fractures of scapular neck was done. The patients were treated by operation or by non-operation from May 1994 to May 2003. According to the degree of displacement, 30 cases included 9 mild displaced fractures(<10 mm) and 21 severe displaced fractures(>10 mm). According to the location of fractures, there were 24 cases of surgical neck fractures and 6 cases of anatomical neck fractures. Of all 30 patients, 12 were treated by non-operation and 18 by operation. All fractured scapular necks were exposed through posterior approach and fixed with interfragmentary compression screws, reconstruction plates and so on after satisfactory reduction. Associated clavicle fractures were exposed through Langer's approach and fixed with Kirschner wire-tension band fixation construct, reconstruction plates and so forth. When followed up, the clinical examination was done and the X-ray films were taken to measure glenopolar angle(GPA). Herscovici's score was adopted.
Twenty-eight patients were followed up from 14 days to 9 years. Among 11 patients treated by non-operation, Herscovici score showed that 4 cases achieved the excellent result, 2 cases good, 2 cases fair and 3 cases poor and the X-ray film results showed that there were 6 cases of GPA>20 degrees and 5 cases of GPA<20 degrees. Of 17 patients treated by operation, Herscovici score showed that 11 cases achieved the excellent result, 5 cases good and 1 case fair and the X-ray film results showed that there 16 cases of GPA>20 degrees and 1 case of GPA<20 degrees .
Fractures of scapular surgical neck with mild displacement can be treated by non-operation, while fractures of surgical neck with severe displacement or associated with ipsilateral clavicle fractures, and fractures of anatomical neck should be treated by operation to reconstruct the stability of shoulder and minimize the complications.
探讨肩胛颈骨折的有效治疗方法。
对1994年5月至2003年5月期间收治的30例肩胛颈骨折患者进行回顾性分析。患者接受手术或非手术治疗。根据移位程度，30例患者中包括9例轻度移位骨折（<10毫米）和21例重度移位骨折（>10毫米）。根据骨折部位，有24例外科颈骨折和6例解剖颈骨折。30例患者中，12例接受非手术治疗，18例接受手术治疗。所有肩胛颈骨折均通过后入路显露，在满意复位后用骨折块间加压螺钉、重建钢板等固定。合并的锁骨骨折通过朗格入路显露，用克氏针张力带固定结构、重建钢板等固定。随访时，进行临床检查并拍摄X线片测量肩胛盂极角（GPA）。采用赫斯科维奇评分。
28例患者获得随访，随访时间为14天至9年。在11例接受非手术治疗的患者中，赫斯科维奇评分显示4例结果为优，2例为良，2例为可，3例为差；X线片结果显示，6例GPA>20度，5例GPA<20度。在17例接受手术治疗的患者中，赫斯科维奇评分显示11例结果为优，5例为良，1例为可；X线片结果显示，16例GPA>20度，1例GPA<20度。
轻度移位的肩胛外科颈骨折可采用非手术治疗，而重度移位的外科颈骨折或合并同侧锁骨骨折以及解剖颈骨折应采用手术治疗，以重建肩部稳定性并减少并发症。
