Ogawa K, Naniwa T
Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
J Shoulder Elbow Surg. 1997 Nov-Dec;6(6):544-8. doi: 10.1016/s1058-2746(97)90087-2.
We studied 37 fractures lateral to the spinoglenoidal notch to evaluate the validity of collectively handling these fractures as an acromion fracture and to ascertain the mechanism of injury. We divided them into three groups according to the location of the fracture line. Fracture of the anatomic acromion or the extremely lateral scapular spine (groups I and II, 28 fractures) was frequently associated with fracture of the coracoid base, acromioclavicular joint injury, or both. The mechanism of injury in most cases was presumed to be indirect force brought to bear on the shoulder from the lateral direction. Fracture descending to the spinoglenoidal notch (group III, nine fractures) was seldom associated with other shoulder injuries, and surgery was rarely needed. The mechanism was assumed to be direct force brought to bear on the shoulder from the posterior direction. Therefore fractures of the anatomic acromion and the extremely lateral scapular spine may be managed collectively. However, fracture descending to the spinoglenoidal notch should be managed separately. We advocate that these fractures should be classified into two types in terms of clinical consideration: type I fractures, comprising those of the anatomic acromion and the extremely lateral scapular spine, and type II fractures, located in the more medial spine and descending to the spinoglenoidal notch.
我们研究了肩胛盂切迹外侧的37处骨折，以评估将这些骨折作为肩峰骨折进行综合处理的有效性，并确定损伤机制。我们根据骨折线的位置将它们分为三组。解剖学肩峰或肩胛冈最外侧的骨折（I组和II组，共28处骨折）常伴有喙突基底骨折、肩锁关节损伤或两者皆有。大多数情况下，损伤机制推测为侧向力间接作用于肩部。延伸至肩胛盂切迹的骨折（III组，9处骨折）很少伴有其他肩部损伤，很少需要手术治疗。其机制假定为后向力直接作用于肩部。因此，解剖学肩峰和肩胛冈最外侧的骨折可进行综合处理。然而，延伸至肩胛盂切迹的骨折应单独处理。我们主张，从临床角度考虑，这些骨折应分为两种类型：I型骨折，包括解剖学肩峰和肩胛冈最外侧的骨折；II型骨折，位于肩胛冈更内侧并延伸至肩胛盂切迹。
