浮肩损伤的治疗策略

目的:探讨浮肩损伤的临床特征及治疗方法。方法:回顾分析2000年7月至2011年5月收治的25例浮肩损伤患者的临床资料,男18例,女7例;年龄17～56岁,平均(36.2±2.3)岁;肩胛颈骨折合并同侧锁骨骨折21例,合并肩锁脱位4例。患者均有合并性损伤。7例保守治疗,7例单纯固定锁骨,11例行双固定。采用Herscovici,Constant和Murley,Rowe评分系统进行功能评定。结果:所有患者得到随访,时间11个月～10年,平均4.6年。除1例锁骨粉碎骨折延迟愈合外,其余骨折均愈合,无伤口感染,内固定物无断裂;2例保守治疗患者出现方肩畸形,其余患者肩关节外形正常。3例臂丛神经损伤患者中2例3个月内恢复,1例半年恢复;肩胛上神经损伤患者1年内恢复。Herscovici评定疗效:优18例,良5例,可1例,差1例。Constant和Murley肩关节评分:总评分(83.2±5.7)分,其中疼痛(12.1±2.5)分,日常活动(17.2±3.2)分,运动范围(32.1±3.5)分,力量(18.5±2.1)分。Rowe评定结果,优18例,良5例,差2例。结论:浮肩损伤系高能量损伤,破坏上肩胛悬吊复合体的稳定性,应根据骨折的移位及粉碎程度,患者的职业及治疗预期选择恰当的治疗方法。

Treatment strategy for the floating shoulder injury

Objective:To explore the clinical features and operative treatment of floating shoulder injuries. Methods:The clinical data of 25 patients with floating shoulder injuries that had been admitted to the hospital from July 2000 to May 2011 were retrospectively analyzed. There were 18 males and 7 females,wirh an average age of (36.2±2.3) years ranging from 17 to 56 years. The scapular neck fractures associated with clavicle fractures were in 21 cases and acromioclavicular joint dislocation in 4 cases. All cases were accompanied by associated injuries. Among of them,7 cases were conservative treatment,7 cases were fixed clavicle only,11 cases were clavicle and scapular. All datum were rated according to Herscovici,Constant and Murley,Rowe rate system. Results:All patients were followed up for 4.6 years (range 11 months to 10 years). All fractures were healed except for 1 clavicle was delay healed. There were not infections and fixation fracture,2 of conservative treatment were dropping shoulder,2 of 3 brachial plexus injuries were recovered 3 months later,1 was 6 months. Suprascapular nerve injury was recoved 1 year later. Herscovici evaluation:18 excellent,5 good,1 fair,1 poor;Constant and Murley shoulder score: (83.2±5.7 ),pain score(12.1±2.5),activities of daily living score(17.2±3.2),range of motion score (32.1±3.5),strength score (18.5±2.1); Rowe evaluation:18 excellent,5 fair,2 poor. Conclusion:Floating shoulder injuries is high energy injury,destroy superior shoulder suspensory complex stability,appropriate treatment should be choosen according to fractures displacement and smash level,patients'professional and anticipation