喙突骨折：一项系统评价
Fractures of the coracoid process: a systematic review.
作者信息
Ogawa Kiyohisa, Matsumura Noboru, Yoshida Atsushi, Inokuchi Wataru
机构信息
Department of Orthopedic Surgery, Eiju General Hospital, Taito-ku, Tokyo, Japan.
Department of Orthopedic Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan.
出版信息
JSES Rev Rep Tech. 2021 May 12;1(3):171-178. doi: 10.1016/j.xrrt.2021.04.008. eCollection 2021 Aug.
BACKGROUND
Although fracture of the coracoid process (CF) used to be considered rare, it is now more commonly encountered due to increased awareness and advances in imaging methods. This review aimed to analyze reported cases of CF to determine its mechanism and appropriate treatment.
METHODS
PubMed and Scopus were searched using the terms "scapula fracture" and "coracoid fracture." The inclusion criteria were English full-text articles concerning CF that described patient characteristics with appropriate images. The exclusion criteria included cases without appropriate images and those with physeal injury or nonunion. Citation tracking was conducted to find additional articles and notable full-text articles in other languages. Fractures were mainly classified using Ogawa's classification.
RESULTS
Ninety-seven studies were identified, including 197 patients (131 men, 33 women; average age 37.0±16.9 years). CF was classified as type I in 77%, type II in 19%, and avulsion fracture at the angle in 5%. Concurrent shoulder girdle injuries included acromioclavicular injury in 33%, clavicular fracture in 17%, acromion or lateral scapular spine fracture in 15%, and anterior shoulder instability in 11%. Among patients with type I CF, 69% had multiple disruptions of the superior shoulder suspensory complex. Conservative treatment was applied in 71% of isolated type I CF, while surgical treatment was applied in 76% of type I CF with multiple disruptions. Although the evaluation methods varied, 60% of patients were followed up for more than 6 months, and the outcomes were generally satisfactory for both conservative and surgical treatments.
CONCLUSION
CF occurred commonly in the age group with higher social activity. The most common fracture type was type I. The possible mechanism of CF is violent traction of the attached muscles, except for avulsion fracture at the angle. Type I CF with multiple disruptions of the superior shoulder suspensory complex requires surgical treatment, whereas conservative care is recommended for isolated type I and type II CFs.
背景
尽管喙突骨折（CF）过去被认为较为罕见，但由于认识的提高和成像方法的进步，现在其更为常见。本综述旨在分析已报道的CF病例，以确定其机制和合适的治疗方法。
方法
使用“肩胛骨骨折”和“喙突骨折”等术语在PubMed和Scopus上进行检索。纳入标准为关于CF的英文全文文章，这些文章描述了患者特征并配有合适的图像。排除标准包括没有合适图像的病例以及存在骨骺损伤或骨不连的病例。进行引文追踪以查找其他文章和其他语言的重要全文文章。骨折主要采用小川分类法进行分类。
结果
共识别出97项研究，包括197例患者（男性131例，女性33例；平均年龄37.0±16.9岁）。CF的分类为I型占77%，II型占19%，角部撕脱骨折占5%。并发的肩胛带损伤包括肩锁关节损伤占33%，锁骨骨折占17%，肩峰或肩胛外侧缘骨折占15%，以及肩关节前不稳定占11%。在I型CF患者中，69%存在肩上部悬吊复合体的多处断裂。71%的孤立性I型CF采用保守治疗，而76%的伴有多处断裂的I型CF采用手术治疗。尽管评估方法各不相同，但60%的患者随访时间超过6个月，保守治疗和手术治疗的结果总体上都令人满意。
结论
CF常见于社交活动较多的年龄组。最常见的骨折类型为I型。CF的可能机制是附着肌肉的暴力牵拉，角部撕脱骨折除外。伴有肩上部悬吊复合体多处断裂的I型CF需要手术治疗，而孤立性I型和II型CF建议采用保守治疗。
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