Branca Vergano Luigi, Monesi Mauro
U.O. Ortopedia e Traumatologia, Ospedale M. Bufalini, Cesena (FC).
Acta Biomed. 2018 Nov 15;90(1-S):150-153. doi: 10.23750/abm.v90i1-S.7857.
Background and aim of the work The term "floating shoulder" was used in a previous paper to describe lesions of at least two components of the SSSC (superior shoulder suspensory complex), a bony-ligamentous structure of the shoulder girdle. Following this article other types of floating shoulder were described, including scapulothoracic dissociation (STD), a rare lesion with potentially devastating consequences, with detachment of the scapular body from the thoracic wall, with following lateralization of the scapula, fracture of the clavicle or injury of the adiacent sterno-clavear or acromion-clavicular joints. Prognosis and outcome are also negatively influenced by secondary vascular and neurologic injuries. Methods We review the literature on this lesion and we describe two patients with STD, their treatment and outcome. Results Reviewing the literature and analysing our cases, we point out that the STD is often associated with serious general lesions and is indicative of an high-energy trauma. The consequences can be disabling for the upper limb (20% amputation, 50% flail limb) or for the general status of the patient (10% mortality). Conclusions STD must be timely recognized and subsequently properly treated, to avoid the associated general and local injuries (vascular) and subsequently the musculoskeletal lesions.
工作背景与目的 “漂浮肩” 一词在之前的一篇论文中用于描述肩带骨韧带结构 —— 肩上部悬吊复合体（SSSC）至少两个组成部分的损伤。在这篇文章之后，又描述了其他类型的漂浮肩，包括肩胛胸壁分离（STD），这是一种罕见的损伤，可能产生严重后果，表现为肩胛骨体与胸壁分离，随后肩胛骨向外侧移位，伴有锁骨骨折或相邻的胸锁关节或肩锁关节损伤。继发性血管和神经损伤也会对预后和结果产生负面影响。方法 我们回顾了关于该损伤的文献，并描述了两名肩胛胸壁分离患者及其治疗方法和结果。结果 通过回顾文献并分析我们的病例，我们指出肩胛胸壁分离常与严重的全身损伤相关，提示为高能量创伤。其后果可能导致上肢功能丧失（20%截肢，50%连枷肢）或患者整体状况不佳（10%死亡率）。结论 必须及时识别肩胛胸壁分离并随后进行恰当治疗，以避免相关的全身和局部损伤（血管损伤）以及随后的肌肉骨骼病变。
