Scollan Joseph P, Chughtai Morad, Evans Peter J, Styron Joseph F
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
Department of Orthopaedic Surgery, Cleveland Clinic Martin Health, Stuart, FL, USA.
JSES Rev Rep Tech. 2021 Feb 27;1(2):118-126. doi: 10.1016/j.xrrt.2021.01.003. eCollection 2021 May.
Historically, scapulothoracic fusion (STF) is performed using steel wire and plate construct fixation. The purpose of this study is to report a recent fusion achieved through ultra-high-molecular-weight polyethylene-reinforced suture fixation as well as to perform a systematic literature review of techniques, fusion rates, complications, and reoperation.
Patient data were gathered from chart review and clinical encounters. For the review, MEDLINE, Embase, and Ovid databases were queried for STF cases. Thirty articles reporting on 386 fusion procedures were included.
Including this patient, 5 of 387 (1.3%) STFs have been attempted with fiber suture. Fusion rates of metal-only constructs is 90.8% (346 of 381) with 11.3% (43 of 381) requiring wire removal or trimming because of symptomatic hardware and 7% (27 of 381) causing a postoperative pneumothorax. Although a small sample size, all fiber-suture constructs have achieved union without implant removal and without pneumothorax development. In this patient, fusion was determined radiographically at 6 months with substantial improvement in pain level and function.
Scapulothoracic fusion has benefit to patients to have failed other management options for winged scapula, most commonly those with neurologic trauma or facioscapulohumeral muscular dystrophy. With advancements in surgical options, fiber-suture offers an alternative to steel wire to achieve fusion. Further cases with longer term follow-up are needed to determine if significant differences in outcomes exist between constructs.
历史上，肩胛胸壁融合术（STF）采用钢丝和钢板结构固定。本研究的目的是报告近期通过超高分子量聚乙烯增强缝线固定实现的融合情况，并对技术、融合率、并发症和再次手术进行系统的文献综述。
通过病历回顾和临床会诊收集患者数据。为进行综述，在MEDLINE、Embase和Ovid数据库中查询STF病例。纳入了30篇报告386例融合手术的文章。
包括该患者在内，387例STF中有5例（1.3%）尝试使用纤维缝线。仅金属结构的融合率为90.8%（381例中的346例），11.3%（381例中的43例）因硬件相关症状需要取出或修剪钢丝，7%（381例中的27例）导致术后气胸。尽管样本量较小，但所有纤维缝线结构均实现了融合，无需取出植入物，也未发生气胸。在该患者中，6个月时通过影像学检查确定融合，疼痛程度和功能有显著改善。
肩胛胸壁融合术对其他治疗翼状肩胛的方法失败的患者有益，最常见于神经创伤或面肩肱型肌营养不良患者。随着手术选择的进步，纤维缝线为实现融合提供了一种替代钢丝的方法。需要更多长期随访的病例来确定不同结构之间在结果上是否存在显著差异。
