Sewell M D, Higgs D S, Al-Hadithy N, Falworth M, Bayley I, Lambert S M
Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
J Bone Joint Surg Br. 2012 Sep;94(9):1253-9. doi: 10.1302/0301-620X.94B9.29402.
Scapulothoracic fusion (STF) for painful winging of the scapula in neuromuscular disorders can provide effective pain relief and functional improvement, but there is little information comparing outcomes between patients with dystrophic and non-dystrophic conditions. We performed a retrospective review of 42 STFs in 34 patients with dystrophic and non-dystrophic conditions using a multifilament trans-scapular, subcostal cable technique supported by a dorsal one-third semi-tubular plate. There were 16 males and 18 females with a mean age of 30 years (15 to 75) and a mean follow-up of 5.0 years (2.0 to 10.6). The mean Oxford shoulder score improved from 20 (4 to 39) to 31 (4 to 48). Patients with non-dystrophic conditions had lower overall functional scores but achieved greater improvements following STF. The mean active forward elevation increased from 59° (20° to 90°) to 97° (30° to 150°), and abduction from 51° (10° to 90°) to 83° (30° to 130°) with a greater range of movement achieved in the dystrophic group. Revision fusion for nonunion was undertaken in five patients at a mean time of 17 months (7 to 31) and two required revision for fracture. There were three pneumothoraces, two rib fractures, three pleural effusions and six nonunions. The main risk factors for nonunion were smoking, age and previous shoulder girdle surgery. STF is a salvage procedure that can provide good patient satisfaction in 82% of patients with both dystrophic and non-dystrophic pathologies, but there was a relatively high failure rate (26%) when poor outcomes were analysed. Overall function was better in patients with dystrophic conditions which correlated with better range of movement; however, patients with non-dystrophic conditions achieved greater functional improvement.
肩胛胸壁融合术（STF）用于治疗神经肌肉疾病中肩胛翼状突出引起的疼痛，可有效缓解疼痛并改善功能，但关于营养不良和非营养不良患者的治疗效果比较，相关信息较少。我们对34例患有营养不良和非营养不良疾病的患者进行了42次STF手术的回顾性研究，采用多丝经肩胛、肋下缆线技术，并辅以背侧三分之一半管状钢板。患者共16例男性和18例女性，平均年龄30岁（15至75岁），平均随访5.0年（2.0至10.6年）。牛津肩评分平均从20分（4至39分）提高到31分（4至48分）。非营养不良患者的总体功能评分较低，但STF术后改善更大。平均主动前屈从59°（20°至90°）增加到97°（30°至150°），外展从51°（10°至90°）增加到83°（30°至130°），营养不良组的活动范围更大。5例患者因骨不连进行了翻修融合，平均时间为17个月（7至31个月），2例因骨折需要翻修。发生了3例气胸、2例肋骨骨折、3例胸腔积液和6例骨不连。骨不连的主要危险因素是吸烟、年龄和既往肩胛带手术。STF是一种补救手术，对于患有营养不良和非营养不良疾病的患者，82%的患者对其满意度较高，但分析不良结果时，失败率相对较高（26%）。营养不良患者的总体功能较好，这与更好的活动范围相关；然而，非营养不良患者的功能改善更大。
