Giannini Sandro, Faldini Cesare, Pagkrati Stavroula, Grandi Gianluca, Digennaro Vitantonio, Luciani Deianira, Merlini Luciano
Department of Orthopaedic Surgery, University of Bologna, Istituto Ortopedico Rizzoli, Italy, Via G. Pupilli 1, 40136 Bologna, Italy.
Clin Med Res. 2007 Oct;5(3):155-62. doi: 10.3121/cmr.2007.736.
To verify if stabilizing the scapulothoracic joint without arthrodesis could lead to functional improvement of shoulder range of motion and clinical improvement of winged scapula, we incorporated four additional patients into our previous analysis to determine if the results obtained were long lasting, and to compare this fixation with the other techniques described in the literature, balancing the benefits with the complications.
A retrospective study.
Thirteen patients with bilateral winged scapula affected by facioscapulohumeral muscular dystrophy. Nine of these patients had been analyzed in our previous study.
Patients were operated on by bilateral fixing of the scapula to the rib cage using metal wires without arthrodesis (scapulopexy).
All patients experienced improvement in active range of motion of the shoulder and all of them had clinical improvement with complete resolution of the winged scapula. In all twenty-six surgical interventions of scapulopexy, a stable and long-lasting fixation of the scapula to the rib cage was achieved. The complications strictly associated to the surgical technique encountered were one pneumothorax, which was resolved spontaneously, and one wire breakage without trauma. Average follow-up was 10 years (range, 3 to 18 years).
The scapulopexy used in this extended series of patients consisted of repositioning the scapula and fixing it to four ribs by using metal wires without performing arthrodesis. This technique has a low rate of complications, is reproducible, safe and effective, resulting in clinical and functional improvement.
为了验证在不进行关节融合的情况下稳定肩胛胸壁关节是否能改善肩部活动范围的功能以及改善翼状肩胛的临床症状,我们将另外4名患者纳入先前的分析,以确定所获得的结果是否持久,并将这种固定方法与文献中描述的其他技术进行比较,权衡其益处与并发症。
一项回顾性研究。
13例患有面肩肱型肌营养不良症且双侧出现翼状肩胛的患者。其中9例患者曾在我们先前的研究中接受过分析。
通过使用金属丝将肩胛骨双侧固定至胸廓而不进行关节融合(肩胛固定术)对患者进行手术。
所有患者的肩部主动活动范围均有改善,且翼状肩胛完全消失,临床症状均得到改善。在所有26例肩胛固定术手术中,肩胛骨与胸廓均实现了稳定且持久的固定。与手术技术严格相关的并发症为1例自发性气胸和1例无外伤的金属丝断裂。平均随访时间为10年(范围为3至18年)。
在这组扩大的患者系列中使用的肩胛固定术包括重新定位肩胛骨,并使用金属丝将其固定至四根肋骨,而不进行关节融合。该技术并发症发生率低,可重复操作,安全有效,能带来临床和功能改善。