Maria S W, Sapuan J, Abdullah S
Department of Orthopaedics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia.
Malays Orthop J. 2015 Jul;9(2):54-56. doi: 10.5704/MOJ.1507.002.
Scapulo-thoracic dissociation is an infrequent injury resulting from high energy trauma which is often associated with severe neurological and vascular injuries which may be unrecognised at the time of presentation. A 24 year-old female presented with bilateral rib fractures, pneumothorax, liver and kidney injuries following a road traffic accident. She also sustained fractures of her right scapula, odontoid, right transverse processes of the thoracic and lumbar vertebrae and a closed fracture of her right femur. Her right upper limb was later noted to be flail and pulseless, due to complete right brachial plexus injury, scapula-thoracic dissociation and subclavian artery avulsion. We managed the upper limb injuries non-operatively, and focused on resuscitation of the patient. Early exploration of the complete brachial plexus injury was not undertaken in spite of the possible associated poor functional outcome as there was no life-threatening indication.
肩胛胸壁分离是一种由高能创伤导致的罕见损伤，常伴有严重的神经和血管损伤，在就诊时可能未被识别。一名24岁女性在道路交通事故后出现双侧肋骨骨折、气胸、肝和肾损伤。她还伴有右肩胛骨、齿突、胸腰椎右侧横突骨折以及右股骨闭合性骨折。后来发现她的右上肢呈连枷状且无脉搏，这是由于完全性右臂丛神经损伤、肩胛胸壁分离和锁骨下动脉撕脱所致。我们对上肢损伤采取了非手术治疗，并着重对患者进行复苏。尽管可能会有功能预后不良的情况，但由于没有危及生命的指征，并未对完全性臂丛神经损伤进行早期探查。
