Chen Xi, Deng Ya-Dian, Qiu Xu-Sheng, Chen Yi-Xin, Zhang Zi-Tao
Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China.
Department of Shoulder and Elbow Surgery, Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Zhengzhou, China.
Quant Imaging Med Surg. 2023 Aug 1;13(8):5130-5140. doi: 10.21037/qims-23-278. Epub 2023 Jun 13.
The choice of treatment for scapular fractures is a topic worth discussing. The type of scapular fracture is often complex, and more and more scholars prefer surgical treatment to obtain better shoulder joint function. In addition, because of the rich blood supply and muscles of the scapula, some scholars believe that simple suspension can also achieve satisfactory clinical effects. The aim of this study was to investigate the curative effect and prognostic factors of patients with scapular fracture with indications for surgery after receiving conservative treatment.
Patients with scapular fracture who did not receive surgical treatment from July 2016 to May 2021 were recruited from the orthopedic trauma database of Nanjing Gulou Hospital, and the data from patients with indications for surgery were screened out for a retrospective analysis. The data were obtained from the database of orthopaedic trauma patients in Nanjing Drum Tower Hospital. The relevant data were recorded during telephone and video follow-up visits. Linear regression was used to analyze the factors associated with disabilities of the arm, shoulder and hand (DASH) score after receiving conservative treatment.
A total of 21 patients were included in the final statistical analysis. All patients were followed up for 31.0±20.3 (range, 6-63) months, aged 52.9±12.7 (range, 27-71) years. All fractures had clinical healing with a 100% recovery satisfaction rate. Outcome measures of efficacy [both DASH scores and visual analogue scale (VAS) scores], were correlated with whether the fracture involved the superior border of the scapular, were not associated with the following variables: age (P=0.18), Injury Severity Score (ISS) score (P=0.10), the glenopolar angle (GPA) value (P=0.76), superior shoulder suspensory complex (SSSC) injury (P=0.82), and glenoid fracture (P=0.84). The range of motion of the affected shoulder was significantly reduced compared to the healthy shoulder (P<0.01), but the range of forward flexion and elevation was not significantly different from that of the healthy shoulder (P>0.05). Patients with fractures not involving the superior border of the scapula had a much lower range of motion in the affected shoulder than in the healthy shoulder during abduction (P<0.05).
The range of surgical indications for scapular fractures with scapular fractures involving the lower margin of the scapular can be appropriately narrowed. Some patients with scapular fracture who have surgical indications can regain satisfactory shoulder function after receiving conservative treatment.
肩胛骨骨折的治疗选择是一个值得探讨的话题。肩胛骨骨折类型往往复杂，越来越多的学者倾向于手术治疗以获得更好的肩关节功能。此外，由于肩胛骨血供丰富且肌肉附着多，一些学者认为单纯悬吊也可取得满意的临床效果。本研究旨在探讨有手术指征的肩胛骨骨折患者保守治疗后的疗效及预后因素。
从南京鼓楼医院骨科创伤数据库中选取2016年7月至2021年5月未接受手术治疗的肩胛骨骨折患者，筛选出有手术指征患者的数据进行回顾性分析。数据来源于南京鼓楼医院骨科创伤患者数据库。通过电话及视频随访记录相关数据。采用线性回归分析保守治疗后与上肢、肩部和手部功能障碍（DASH）评分相关的因素。
最终纳入21例患者进行统计学分析。所有患者随访31.0±20.3（范围6 - 63）个月，年龄52.9±12.7（范围27 - 71）岁。所有骨折均临床愈合，恢复满意率达100%。疗效指标[DASH评分和视觉模拟量表（VAS）评分]与骨折是否累及肩胛骨上缘相关，与以下变量无关：年龄（P = 0.18）、损伤严重度评分（ISS）（P = 0.10）、关节极角（GPA）值（P = 0.76）、肩上部悬吊复合体（SSSC）损伤（P = 0.82）和关节盂骨折（P = 0.84）。患侧肩部活动范围与健侧相比明显减小（P < 0.01），但前屈和上举范围与健侧相比差异无统计学意义（P > 0.05）。肩胛骨骨折未累及上缘的患者，患侧肩部外展时活动范围较健侧明显减小（P < 0.05）。
对于累及肩胛骨下缘的肩胛骨骨折，手术指征范围可适当缩小。部分有手术指征的肩胛骨骨折患者保守治疗后可恢复满意的肩部功能。
