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英国一家一级创伤中心的肩胛骨骨折治疗

Management of Scapula Fractures at a Level 1 Trauma Centre in the United Kingdom.

作者信息

Khan Basharat Ghafoor, Ali Muhammad Usman, Farrukh Sadia, Jamshed Muhammad, Rasool Muhammad Umer, Aresti Nick

机构信息

Trauma and Orthopaedics, Mersey and West Lancashire Teaching Hospitals NHS Trust, St. Helens, GBR.

Orthopaedics and Trauma, Health Education England North West London, London, GBR.

出版信息

Cureus. 2024 Dec 2;16(12):e74947. doi: 10.7759/cureus.74947. eCollection 2024 Dec.

Abstract

Background Scapular fractures, an uncommon injury that can be brought on by a high-energy mechanism because of its proximity to the pectoral and shoulder muscles, are frequently linked to fatal injuries. This study aimed to compare surgical versus conservative treatment of scapular fractures and the results of treated patients. Methods The traumatic scapular fracture patients in this cross-sectional study (n = 391) were treated at a major trauma centre (level 1) in the United Kingdom between 2012 and 2018. Patients underwent a computed tomography (CT) scan of a scapula fracture with standard axial, coronal, and sagittal slices and a 3D reconstruction view based on an initial X-ray diagnosis. The Ideberg classification method was used to categorize all intra-articular scapular fractures. The two-tailed independent t-test was used to compare the surgical group to the traditionally conservative group. A p-value <0.05 was considered statistically significant. Results Scapular fractures were pre-dominant in males (82.09%, 321/391) with age (mean + SD) 43 + 1.23 years, and 76% (297/391) had 15 injury severity scores. Trauma with high energy was seen in 91% of cases for scapula fractures, whereas 93% were identified as polytrauma patients. The Advanced Trauma Life Support (ATLS) was performed in 92% of patients. The other injuries found were thorax (29.2%), limbs (21.2%), and spine (18.1%). A statistically insignificant (p-value = 0.135) difference was seen in the patients with surgery (EuroQol five-dimension five-level (EQ-5D-5L) score = 7.30) than nonoperative (EQ-5D-5L score = 6.14). Conclusions Based on our results, conservative management had better outcomes, but surgical options must be explored in selected cases as the difference in outcomes is not statistically significant.

摘要

背景 肩胛骨骨折是一种不常见的损伤,由于其靠近胸肌和肩部肌肉,可由高能机制导致,常与致命伤相关。本研究旨在比较肩胛骨骨折的手术治疗与保守治疗以及治疗患者的结果。方法 本横断面研究中的创伤性肩胛骨骨折患者(n = 391)于2012年至2018年在英国一家主要创伤中心(1级)接受治疗。患者根据最初的X线诊断进行肩胛骨骨折的计算机断层扫描(CT),包括标准的轴位、冠状位和矢状位切片以及三维重建视图。采用Ideberg分类方法对所有关节内肩胛骨骨折进行分类。采用双尾独立t检验比较手术组与传统保守组。p值<0.05被认为具有统计学意义。结果 肩胛骨骨折以男性为主(82.09%,321/391),年龄(平均±标准差)为43±1.23岁,76%(297/391)的患者损伤严重程度评分为15分。91%的肩胛骨骨折病例为高能创伤,而93%的患者被确定为多发伤患者。92%的患者接受了高级创伤生命支持(ATLS)。发现的其他损伤包括胸部(29.2%)、四肢(21.2%)和脊柱(18.1%)。手术患者(欧洲五维五级健康量表(EQ-5D-5L)评分为7.30)与非手术患者(EQ-5D-5L评分为6.14)之间的差异无统计学意义(p值 = 0.135)。结论 根据我们的结果,保守治疗的效果更好,但在某些特定情况下必须探索手术选择,因为结果差异无统计学意义。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/17e1/11688606/d99e00c8c97b/cureus-0016-00000074947-i01.jpg

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