肩胛骨骨折手术疗效分析

肩胛骨为扁宽形不规则骨,位于胸廓后上方两侧,周围有较多肌肉包绕和丰富的血液供给,特别是肩胛体部,其前后的肌肉对骨折起着"夹板"的作用,因此肩胛骨骨折多数不会造成较大移位和不愈合.对于大部分稳定骨折均可采取保守治疗,但对于粉碎性移位明显的复杂骨折,单纯保守治疗效果欠佳,易并发骨折畸形愈合、肌肉瘢痕挛缩等并发症,而致使肩胛骨胸壁粘连固定,从而影响肩胛骨滑动[1].     

手术治疗肩胛骨骨折23例疗效分析

目的探讨手术治疗肩胛骨骨折的内固定方式及其疗效。方法手术治疗23例肩胛骨骨折患者,14例采用后方Judet入路,2例采用前后方联合入路,1例喙突骨折与2例盂部前方骨折采用前方入路,2例肩峰骨折采用骨折处直接切开,2例盂部后方骨折采用后方肩胛骨外缘直接切开。16例伴有肩胛骨多处骨折采用钢板螺钉固定,1例喙突骨折及2例关节盂骨折采用拉力螺钉固定,2例肩峰骨折分别采用克氏针和钢丝环扎,2例关节盂骨折采用可吸收螺钉固定。结果 21例获得随访,时间9～55个月。骨折均愈合。采用体格检查及肩关节Constant评分标准进行疗效评价:优11例,良7例,可2例,差1例。术后并发浅表感染1例,外展>90°时轻微疼痛2例,肩胛上神经卡压1例。结论对于达到手术指征的肩胛骨骨折,适合的手术入路及内固定可以达到满意治疗效果。     

多发伤中肩胛骨骨折的手术疗效分析

[目的]探讨手术治疗多发伤中肩胛骨骨折的内固定方式及其疗效。[方法]14例患者肩胛骨骨折行骨折切开复位内固定术,其中合并胸部外伤9例,肱骨外科颈骨折2例,锁骨骨折或肩锁关节脱位6例,脑外伤2例,胫腓骨骨折1例,股骨颈骨折1例,臂丛神经损伤1例。单纯肩胛岗骨折2例,肩胛盂骨折1例,肩胛骨体部骨折11例。[结果]14例获得随访,门诊随访6~48个月,平均愈合时间10.3周(8~14周)。无内固定松动或感染病例。均达到骨性愈合。根据Hardegger功能评定标准评定疗效:优9例,良4例,可1例。[结论]对于达到手术指征的多发伤中的肩胛骨骨折,恰当的术前诊断及评估,适合的手术入路及内固定可以达到满意治疗效果。     

肩胛骨骨折的疗效分析

肩胛骨骨折的疗效分析山西省人民医院（０３００１２）史书怀我院１９７４～１９９４年治疗２６例肩胛骨骨折，本文就肩胛骨骨折的治疗效果及影响肩关节功能的因素，分析如下。临床资料本组２６例中男２４例，女２例；年龄１５～７６岁；交通事故伤１２例，高处坠落伤８例...     

手术治疗不稳定型肩胛骨骨折的疗效分析

目的 探讨不稳定型肩胛骨骨折的手术入路及疗效.方法 2005年3月至2010年12月共收治42例不稳定型肩胛骨骨折患者,男29例,女13例;年龄22～ 65岁,平均36.3岁.骨折按Hardegger等提出的分型:42例均为不稳定型肩胛骨骨折,其中肩胛体骨折18例,肩胛颈骨折11例,肩峰骨折4例,肩胛冈骨折3例,盂缘骨折3例,喙突骨折2例,盂窝骨折l例.受伤至手术时间为3～19d,平均6.6d.根据骨折类型选择不同的手术入路进行治疗.结果 42例患者术后获9～24个月(平均13.7个月)随访.骨折愈合时间平均为8周,无内固定断裂、松动、骨折不愈合及神经血管损伤等并发症发生.按照Hardegger提出的评定标准评价患肩功能:优27例,良9例,可5例,差l例,优良率为85.7％.结论 对于不稳定型肩胛骨骨折,早期手术治疗可获得良好的疗效,应根据骨折类型选择不同手术入路.     

手术治疗肩胛骨骨折

<正>2005年1月~2012年12月,我科对20例肩胛骨骨折患者根据不同类型采用不同手术入路进行早期内固定治疗,取得良好效果,报道如下。1材料与方法1.1病例资料本组20例,男12例,女8例,年龄20~67岁。均为单侧肩胛骨骨折。骨折按解剖区域分型:肩胛盂骨折3例,肩胛颈骨折4例,肩胛体骨折6例,肩胛冈骨折4例,肩峰骨折2例,喙突骨折1例。合并伤:多发性肋骨骨     

手术治疗肩胛骨骨折

目的：探讨手术治疗肩胛骨骨折的适应证、手术方法及疗效。方法：自1996年4月～2004年1月采用钢板、螺钉及钢丝内固定治疗肩胛骨骨折14例。结果：随访时间9个月～3年，骨折均愈合，1例盂窝骨折肩关节外展受限。结论：行螺旋CT三维重建对于诊断、骨折的分型及治疗方案有重要意义。手术治疗肩胛骨骨折可早期功能锻炼，减少并发症。     

手术治疗肩胛骨骨折

正2012年1月~2015年1月,我科手术治疗14例肩胛骨骨折患者,效果满意,报道如下。1材料与方法1.1病例资料本组14例,男11例,女3例,年龄19~55岁。左侧8例,右侧6例。肩峰喙突骨折1例,体部骨折12例,颈部骨折1例。受伤至手术时间7~14 d。1.2治疗方法全身麻醉下手术。患侧上肢消毒包扎放置于手术台上,以便     

肩胛骨骨折的手术治疗

目的探讨切开复位内固定治疗肩胛骨骨折的适应证及疗效。方法对7例患者经肩后路行切开复位，采用重建钢板、拉力螺钉或克氏针内固定，术后早期功能锻炼。结果本组随访12～36个月，疗效评定为优5例，良1例，可1例。结论在严格掌握手术指征的基础上对肩胛骨骨折行内固定治疗，有利于早期功能锻炼．减少并发症，肩关节功能恢复较好。     

肩胛骨骨折的手术治疗

肩胛骨为近似三角形的不规则扁骨,位于胸廓上方两侧偏后,在肩关节活动中起重要作用.首先它为上肢活动提供肌肉止点,如前方的肩胛下肌、后方的冈上肌、冈下肌和小圆肌,均起自肩胛骨,共同组成肩袖,是维持肩关节动态稳定、完成肩关节活动的最重要结构;其次,肩胛骨在斜方肌、大小菱形肌、背阔肌以及前锯肌等共同作用下,经过肩胛胸壁关节,完成肩胛骨的前伸、回缩以及向上旋转和向下旋转的运动;在肩关节上举过程中,肩胛盂关节面同时向上方旋转,为完成上举活动提供了稳定的平台,协助肩关节完成上举运动(图1)[1].     

Fractures of the femoral shaft treated by plating

Eighty-six fractures of the femoral shaft were treated by open reduction and plating. Seventy-seven fractures (90 per cent) were reviewed 12-72 months (average 38 months) after operation. An excellent or good result was achieved in 70 fractures (91 per cent). There was no case of deep infection. The most common complication was a fatigue fracture of the plate, which occurred in five cases. In patients over the age of 60 years, loosening of the implant was troublesome. Primary bone grafting is essential if rigid internal fixation is not obtained. Plating is an excellent method of treating fractures of the femoral shaft in patients under the age of 60 years, provided that the surgeon is technically competent and experienced in this method of treatment.     

锁定加压钢板治疗肱骨近端骨折

目的 探讨肱骨近端锁定加压钢板(LPHP)治疗肱骨近端骨折的疗效.方法 对2005年2月至2009年6月经肩关节前外侧入路应用LPHP治疗且获得完整随访的52例肱骨近端骨折患者资料进行回顾性分析,其中男21例,女31例;年龄26～86岁,平均53.2岁.骨折按Neer分型:二部分骨折8例,三部分骨折30例,四部分骨折14例.其中合并骨质疏松13例,23例因骨缺损术中以自体骨或其他骨替代物植骨.结果 52例患者获6～50个月(平均18个月)随访,骨折均获愈合,愈合时间10～16周.按Neer肩关节功能评分标准:优33例,良10例,可9例,优良率为82.7%.结论 应用LPHP治疗肱骨近端骨折具有手术方法简单、微创固定可靠、并发症少、骨折愈合率高、肩关节功能恢复好等特点,是一种理想的治疗方法,尤其适用于骨质疏松患者.     

锁定加压钢板治疗肱骨近端骨折的疗效分析

目的 探讨锁定加压钢板治疗肱骨近端骨折的疗效.方法 2005年3月至2010年2月应用锁定加压钢板治疗且获得随访的41例肱骨近端骨折患者,男23例,女18例;年龄20～67岁,平均52.5岁.按Neer分型:二部分骨折11例,三部分骨折22例,四部分骨折8例.受伤至手术时间为4～7 d,平均6.0 d.术后均不行外固定,术后3 d开始行轻度的肩关节主动或被动练习.根据Neer功能评定标准评定术后疗效.结果 41例患者术后获6～38个月(平均24个月)随访,均获骨性愈合,愈合时间为6～10个月,平均7.8个月.根据Neer功能评定标准评定疗效:优29例,良8例,可3例,差1例,优良率为90.2%.无骨不连、肱骨头坏死发生. 结论锁定加压钢板治疗肱骨近端骨折疗效可靠,有利于肩关节早期功能锻炼.     

Fractures of the distal tibia treated with closed reduction and minimally invasive plating

Introduction The treatment of fractures of the distal tibia can be problematical because of the thin soft-tissue covering. Bridging slide-insertion plate osteosynthesis is performed by indirect, axially correct reduction of the fracture and stabilization without opening the soft tissue at the fracture site. Stripping of the periosteum is thus avoided, the fragments remain integrated into the soft tissue, and healing occurs spontaneously by way of callus formation.Materials and methods Seventy-one patients treated by slide-insertion plate osteosynthesis were followed up over at least 2 years. As would be expected in this anatomical region, the proportion of C fractures and fractures with concomitant soft-tissue damage was high. The majority of patients were treated by application of an external fixator on the day of the accident; the definitive osteosynthesis with the slide-insertion plate was performed at a later date after healing of the soft tissues.Results In 68 patients, fracture healing was achieved within 2 years. In 80% of the cases, the final X-ray follow-up showed no or tolerable axis deviations (<5°) in the varus/valgus plane or in the recurvation/antecurvation plane. A deviation >10° requiring a correcting osteotomy was found in only 1 patient. Postoperative complications were rare occurrences. Five patients required an additional cancellous bone graft to deal with inadequate bone healing. System-related complications (instability, malalignment) due to intraoperative technical errors only had to be corrected in revision operations in 2 patients.Conclusion Closed reduction and minimally invasive plating offers the combined advantages of minimal soft-tissue damage with stable fracture fixation.     

Fractures of the distal third of the clavicle treated by hook plating

We retrospectively assessed the union and shoulder function following hook plate fixation in 18 patients with Neer type 2 fractures of the lateral end of the clavicle. The average age was 40 (range 22-62) years, and the mean follow-up was 25 (range 6-48) months. Fifteen patients had acute fractures and the rest were non-unions. Complications included two non-unions, one following a deep infection. There were no iatrogenic fractures. Acromial osteolysis was seen in five patients who had their plates in situ. The average pain score at rest was 1 (range 0-4), and the average pain score on abduction was 2.2 (range 0-5). The average Constant score was 88.5 (range 63-100). Patients were asked to rate their shoulder function; three rated it as normal, 11 as nearly normal and one as not normal. Hook plate fixation appears to be a valuable method of stabilising Neer type 2 fractures of the clavicle, resulting in high union rates and good shoulder function. These plates need to be removed after union to prevent acromial osteolysis.     

Fractures of the femur treated by femoral plating using the anterolateral approach

A review of 56 fractures of the femoral shaft plated by the anterolateral approach was undertaken. The final results were graded as excellent or good in 37 cases (66 per cent). Loss of flexion of the knee of more than 10 ° occurred in 17 cases (30 per cent); these were mostly patients whose plating was delayed by more than 14 days, or was done as a secondary procedure. Patients with open fractures and with other fractures in the same femur tended to have poorer final results. The late complication rate was 18 per cent, which was similar to that for the posterolateral approach for plating the femoral shaft. It is our view that the anterolateral approach is satisfactory for plating the femoral shaft.     

Young patients with shoulder chondrolysis following arthroscopic shoulder surgery treated with total shoulder arthroplasty

Chondrolysis following shoulder arthroscopy is a devastating complication, often seen in young patients. After nonoperative measures have been exhausted, there are few treatment options available that reliably improve pain and function. The purpose of this study is to examine the intra-operative findings, radiographic features, and clinical outcomes of a series of patients with chondrolysis following arthroscopic surgery managed with a total shoulder arthroplasty. A retrospective review was performed on 11 patients (average age 39) with shoulder chondrolysis following arthroscopy. Attention was focused on review of the index arthroscopy, radiographs, and functional outcome scores prior to total shoulder arthroplasty, as well as intra-operative cultures, histology, radiographs, and functional outcomes from most recent follow-up. All patients were treated with total shoulder arthroplasty at an average of 26 months after the index arthroscopy. Preoperative and postoperative radiographs were reviewed, and outcomes were compared using validated measurements. Statistically significant improvements in shoulder abduction (89 degrees -123 degrees , P = .027), external rotation (26 degrees -48 degrees , P = .037), total ASES scores (30-77.5, P = .0039), and SST scores (3-8, P = .0078) were noted. Ten patients subjectively rated their outcomes as good or excellent, with 1 as satisfactory. Chondrolysis after shoulder arthroscopy has a rapid clinical progression and is likely multifactorial in etiology. Early results of total shoulder arthroplasty show an opportunity for improvements in pain and function; however, progressive glenoid radiolucencies may develop in these patients.     

Functional outcome of biological condylar blade plating of subtrochanteric fractures

BackgroundThe aim of this study was to review high-energy subtrochanteric fractures treated biologically with the 95° angled blade plate, to assess the time to union and return to work, and to perform a functional evaluation using the traumatic hip rating scale.Patients and methodsThis study is a retrospective review of 22 patients with 23 fractures. Twenty-one patients (96 %) with 22 fractures were available for analysis. The average age was 33 years (range 18–47). There were seventeen males and four females. The right side was involved in fifteen patients, the left in five patients, and one patient had bilateral fractures. Motor vehicle accident was the predominant mode of injury in eleven patients. Seven patients had other associated injuries. 32B2.1 (40 %) was the commonest fracture pattern according to the OTA classification.ResultsThe average follow-up period was 29 months (range 12–49). The mean time to fracture healing was 16 weeks (range 12–32). All patients returned to their pre-fracture occupation (100 %). Eighteen patients (86 %) healed without any additional surgery. The outcome according to the hip rating scale was excellent in ten patients and good in eleven patients. Two patients (9 %) required additional surgery.ConclusionsBiological fixation of subtrochanteric fractures using 95° CBP results in a high union rate with low morbidity and good functional outcome.