Xue Jianqiang, Zhang Hanwen, Jia Le, Hu Xin, Lu Xiaobo, Ge Jianhua
Department of Bone & Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China.
Department of Bone & Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou Sichuan, 646000, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Jan 15;35(1):76-81. doi: 10.7507/1002-1892.202007104.
To investigate the effectiveness of double internal fixations of clavicle and scapula and intraoperative reduction of glenopolar angle in the treatment of floating shoulder injuries.
Between January 2010 and June 2019, 13 patients with floating shoulder injury were treated with double internal fixation of clavicle and scapula and intraoperative reduction of glenopolar angle. There were 11 males and 2 females with an average age of 48 years (range, 25-65 years). The causes of injury included falling from height in 2 cases, traffic accident injury in 3 cases, heavy object injury in 2 cases, and other injuries in 6 cases. There were 2 cases of Ⅰ-B-3 type, 1 case of Ⅰ-C-2 type, 1 case of Ⅰ-C-3 type, 3 cases of Ⅱ-B-2 type, 1 case of Ⅱ-B-3 type, 1 case of Ⅱ-B-4 type, 2 cases of Ⅱ-C-2 type, 1 case of Ⅱ-C-4 type, and 1 case of Ⅱ-D-3 type according to the classification of floating shoulder injury. All patients had unilateral clavicle fracture with scapular neck fracture, 1-4 superior shoulder suspensory complex (SSSC) injuries. The time from injury to operation was 7-17 days, with an average of 12 days. The glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, scapular glenoid up and down angle were measured before and after operation; Constant-Murly score and Herscovici score were used to evaluate the recovery of shoulder joint function.
All incisions healed by first intention, and there was no early postoperative complications such as infection. All 13 cases were followed up 12-48 months, with an average of 25.2 months. Both the clavicle and the scapula had bone union, and the average healing time was 6 months and 4 months respectively. There were no complications such as nonunion, shoulder deformity, plate fracture or failure of internal fixation, acromion impingement syndrome, and frozen shoulder. At last follow-up, the glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, and scapular glenoid up and down angle were all corrected significantly ( <0.05). The pain, function, activity, muscle strength scores, and total score in Constant-Murly score were significantly improved when compared with preoperative scores ( <0.05). According to the Herscovici scoring standard, the shoulder joint function was evaluated as excellent in 8 cases, good in 3 cases, and fair in 2 cases. The excellent and good rate was 84.6%.
Double internal fixation of clavicle and scapula to stabilize SSSC and reduct glenopolar angle during operation is an effective method for treating the floating shoulder injury.
探讨锁骨与肩胛骨双重内固定及术中恢复肩胛盂极角在治疗浮肩损伤中的有效性。
2010年1月至2019年6月，对13例浮肩损伤患者采用锁骨与肩胛骨双重内固定及术中恢复肩胛盂极角进行治疗。其中男性11例，女性2例，平均年龄48岁（范围25 - 65岁）。受伤原因包括高处坠落2例，交通事故伤3例，重物砸伤2例，其他损伤6例。根据浮肩损伤分类，Ⅰ - B - 3型2例，Ⅰ - C - 2型1例，Ⅰ - C - 3型1例，Ⅱ - B - 2型3例，Ⅱ - B - 3型1例，Ⅱ - B - 4型1例，Ⅱ - C - 2型2例，Ⅱ - C - 4型1例，Ⅱ - D - 3型1例。所有患者均为单侧锁骨骨折合并肩胛颈骨折，1 - 4处肩上部悬吊复合体（SSSC）损伤。受伤至手术时间为7 - 17天，平均12天。分别于术前、术后测量肩胛盂极角、肩峰下间隙、肩胛盂前后倾斜角、肩胛盂上下角；采用Constant - Murly评分和Herscovici评分评估肩关节功能恢复情况。
所有切口均一期愈合，术后早期无感染等并发症。13例均获随访，随访时间12 - 48个月，平均25.2个月。锁骨与肩胛骨均达到骨性愈合，平均愈合时间分别为6个月和4个月。无骨不连、肩部畸形、钢板断裂或内固定失败、肩峰撞击综合征及肩周炎等并发症。末次随访时，肩胛盂极角、肩峰下间隙、肩胛盂前后倾斜角及肩胛盂上下角均较术前明显改善（<0.05）。与术前相比，Constant - Murly评分中的疼痛、功能、活动、肌力评分及总分均明显提高（<0.05）。根据Herscovici评分标准，肩关节功能评定为优8例，良3例，可2例。优良率为84.6%。
锁骨与肩胛骨双重内固定以稳定SSSC并在术中恢复肩胛盂极角是治疗浮肩损伤的有效方法。
