Rajfer Rebecca A, Salopek Traci, Mosier Brian A, Miller Mark Carl, Altman Gregory T
Orthopedics. 2020 May 1;43(3):e177-e181. doi: 10.3928/01477447-20200314-05. Epub 2020 Mar 20.
Historically, extra-articular scapular body fractures were treated nonsurgically, but displaced fractures of the glenoid neck can lead to dysfunction. Controversy exists regarding which extra-articular scapular fractures should be treated surgically; however, nonsurgical management of severely displaced scapular body fractures can result in satisfactory outcomes. Inclusion criteria for this study were medial or lateral displacement greater than 2 cm, angular deformity between fracture fragments greater than 45°, or glenopolar angle less than 22°. Functional outcomes included Disabilities of the Arm, Shoulder and Hand (DASH) score, Short Form-36 (SF-36) score, and American Shoulder and Elbow Surgeons (ASES) shoulder score. Radiographs and computed tomography scans were available for all patients. Range of motion (ROM), strength, other injuries, and complications also were recorded. Twelve patients (10 males, 2 females) with a mean age of 45.6 years (range, 29-57 years) underwent follow-up for a mean of 54.1 months (range, 28.2-74.4 months). At latest follow-up, mean DASH score was 8.9 (range, 0-35), mean SF-36 score was 72.2 (range, 57.3-96.1), and mean ASES score was 85.9 (range, 46.7-100). Mean ROM and strength expressed as a percentage of the contralateral side ranged from 88% to 99% and 70% to 93%, respectively. At longest follow-up, 10 patients reported excellent satisfaction with their treatment. There were no radiographic non-unions. One patient with concomitant clavicle and acromion fractures treated surgically had a postoperative infection requiring operative irrigation and debridement. None of the patients required or sought additional treatment. Nonoperative treatment of highly displaced scapular body fractures resulted in good patient satisfaction, satisfactory long-term functional outcomes, and only minor loss of motion and strength. [Orthopedics. 2020;43(3):e177-e181.].
从历史上看，肩胛体关节外骨折采用非手术治疗，但肩胛颈移位骨折可导致功能障碍。对于哪些关节外肩胛骨折应采用手术治疗存在争议；然而，严重移位的肩胛体骨折的非手术治疗可取得满意的结果。本研究的纳入标准为内侧或外侧移位大于2 cm、骨折碎片间成角畸形大于45°或肩胛极角小于22°。功能结果包括上肢、肩部和手部功能障碍（DASH）评分、简明健康调查问卷36项（SF-36）评分以及美国肩肘外科医师学会（ASES）肩部评分。所有患者均有X线片和计算机断层扫描。还记录了活动范围（ROM）、力量、其他损伤和并发症。12例患者（10例男性，2例女性），平均年龄45.6岁（范围29 - 57岁），平均随访54.1个月（范围28.2 - 74.4个月）。在最近一次随访时，平均DASH评分为8.9（范围0 - 35），平均SF-36评分为72.2（范围57.3 - 96.1），平均ASES评分为85.9（范围46.7 - 100）。以对侧为百分比表示的平均ROM和力量分别为88%至99%和70%至93%。在最长随访时，10例患者对其治疗表示非常满意。没有影像学上的骨不连。1例同时伴有锁骨和肩峰骨折并接受手术治疗的患者发生术后感染，需要手术冲洗和清创。没有患者需要或寻求额外治疗。肩胛体高度移位骨折的非手术治疗使患者满意度良好，长期功能结果令人满意，仅伴有轻微的活动和力量丧失。[《骨科学》。2020；43(3):e177 - e181。]
