Assessment of approaches to estimate scapular orientation in children with brachial plexus birth injury

BackgroundChallenges in measuring dynamic scapular orientation limit assessment of scapulothoracic and glenohumeral contributions to shoulder function in children with brachial plexus birth injury (BPBI). Double calibration acromion marker cluster (D-AMC) and linear model approaches have been validated to estimate scapular motion in healthy adults, but neither has been evaluated in BPBI.Research questionAre the linear model and D-AMC approaches able to accurately estimate scapular orientation in children with BPBI at functional arm postures?MethodsSeventeen children with BPBI positioned their affected limbs in 11 static positions while their segment orientations were measured with motion capture. Linear model and D-AMC estimates of scapular orientation were compared against palpation at six of the static positions with functional relevance to BPBI using a three-way repeat measures ANOVA and a comparison of root mean square errors (RMSE) against literature AMC values for healthy adults.ResultsThe D-AMC was similar to palpation across all positions and scapular axes while the linear model differed from palpation in a few instances. RMSEs of the D-AMC (3.7–14.8°) and particularly the linear model (4.6–24.8°) were generally at or beyond the upper range of past AMC analyses on healthy adults (1.6–14.2°), especially for more complex, multiplanar arm postures. Despite the D-AMC outperforming the linear model, this approach still produced clinically meaningful (>10°) errors for roughly (12.7–22.5%) of subjects.SignificanceCurrent methods for estimating dynamic scapular orientation remain less than ideal for BPBI. Use of the D-AMC may be appropriate to gain broad insights into general dynamic scapulothoracic and glenohumeral function; however, given their potential for producing clinically meaningful errors, the D-AMC and linear model are not recommended for diagnostic purposes or outcomes assessment on an individual patient basis unless their patient-specific accuracy has been evaluated and confirmed prior to use.     

Functional outcomes of operative fixation of clavicle fractures in patients with floating shoulder girdle injuries

BackgroundDouble disruptions of the superior suspensory shoulder complex, commonly referred to as ‘floating shoulder’ injuries, are ipsilateral midshaft clavicular and scapular neck/body fractures with a loss of bony attachment of the glenoid. The treatment of ‘floating shoulder’ injuries has been debated controversially for many years. The purpose of this study was to demonstrate the clinical and functional outcomes of patients with ‘floating shoulder’ injuries who underwent operative fixation of the clavicle fracture only.ResultsAll injuries were the result of high-energy mechanisms. Fracture union of the clavicle was seen after initial surgical fixation in the majority of patients (12; 92.3 %). Final pain was reported as minimal (11 cases; 1–3 VAS), moderate (1 case; 4–6 VAS), and high (1 case; 7–10 VAS) at last follow-up. Excellent range of motion (180° forward flexion and abduction) was observed in the majority of patients (8; 61.5 %). The Herscovici score was 12.9 (range 10–15) at 3 months. Unplanned surgeries included two clavicular implant removals and one nonunion revision. None of the patients required reconstruction for scapula malunion after nonoperative management. Twelve patients returned to previous work without restrictions.Conclusions‘Floating shoulder’ injuries with only clavicular fixation return to function despite persistent scapular deformity and some residual pain.Level of evidence Level IV.     

不稳定性肩胛骨骨折的手术治疗与入路选择分析

目的探讨不稳定性肩胛骨骨折的手术治疗及手术入路选择。方法2004年7月-2009年7月治疗不稳定性肩胛骨骨折患者25例,其中开放性骨折取原伤口入路,闭合性骨折分别取肩关节前侧、肩胛骨后侧、肩胛骨外侧缘入路,骨折复位后运用重建钢板、螺钉、钢丝等进行固定。结果所有患者均获随访,随访时间3～20个月,平均11个月。术后复查x线片显示复位满意。根据Hardegger功能评定标准,优18例,良6例,可1例,优良率为96％。结论对不稳定性肩胛骨骨折选择合适的手术入路和固定方法,辅以早期功能锻炼,疗效满意。     

MRI, CT, scintigraphic and histological features of a vanishing scapular eosinophilic granuloma

Introduction  Vanishing bone lesions have been previously described in patients with eosinophilic granuloma. Materials and methods  We present the magnetic resonance imaging, computed tomography, scintigraphic and histological findings in a 26-year-old woman presenting with a painful scapular mass that subsequently completely resolved, compatible with the diagnosis of eosinophilic granuloma. Conclusion  Clinicians should be aware of the multimodality appearances and natural history of resolving eosinophilic granuloma.     

不同类型肩胛骨骨折手术入路的选择

目的 探讨不同类型肩胛骨骨折的手术人路选择标准、适应证及疗效.方法 1997年1月至2007年12月手术治疗肩胛骨骨折161例,男120例,女41例;年龄20～65岁,平均38岁.术前均行CT检查,其中94例行CT三维重建.单纯型骨折54例,混合型骨折107例,共302处.根据Miller分型:Ⅰ A型25例,Ⅰ B型23例,Ⅰ C型25例,ⅡA型26例,ⅡB型28例,ⅡC型29例,Ⅲ型54例,Ⅳ型92例.其中Ⅲ犁肩盂骨折根据Ideberg分型:ⅢA型11例,ⅢB型10例,ⅢC型12例,ⅢD型13例,ⅢE型8例.合并多发伤112例,其中锁骨骨折致浮肩损伤14例,肩胛上神经损伤8例,多发肋骨骨折87例,血气胸和(或)肺挫伤53例,颈椎损伤8例,同侧肩关节脱位15例,同侧肱骨近端骨折12例,肩胛胸壁分离1例.前方入路11例(Ⅰ C型7例、ⅢA型4例),标准后方入路12例(Ⅰ B型3例、Ⅱ型8例、Ⅲ型1例),后上人路14例(Ⅰ A型2例、Ⅰ B型1例、ⅢC型6例、ⅢD型5例),后外入路10例(ⅡA型3例、ⅢB型3例、ⅢC型2例、ⅢD型2例),前后联合入路22例,改良Judet入路92例.结果 所有病例随访3个月以上,其中32例随访1～7年,平均38.5个月.术后3个月Rowe疗效评价,优102例、良33例、可18例、差8例,优良率84.4%.结论 肩胛骨骨折术前需完善影像学检查明确骨折类型和手术目标区.针对骨折类型选择手术入路,以操作安全、简单便捷、出血量少、损伤小、暴露骨折充分为原则.     

钛合金重建钢板结合跟骨钢板治疗浮肩探讨

目的：探讨浮肩损伤的损伤机制、临床特征和治疗方法。方法：回顾分析经手术治疗的8例浮肩损伤患者的临床资料。主要采用钛合金重建钢板联合跟骨钢板内固定手术治疗。结果：7例患者获得随访，随访时间6—34个月。肩胛骨或锁骨骨折全部骨性愈合。根据Herscovici的疗效评价标准，其中优4例，良2例，可1例。术后并发症主要包括三角肌肌力减弱，外展欠佳1例，创伤性关节炎1例。结论：浮肩多为高能量损伤，对其致伤机制及合并伤认识的11盏床意义重大，手术切开复位行钛合金可塑重建钢板结合跟骨钢板内固定治疗浮肩疗效满意。     

限制型肩胛骨假体置换治疗肩胛骨恶性肿瘤的疗效评价

目的 探讨限制型肩胛骨假体置换治疗肩胛骨恶性肿瘤的效果。方法 回顾性分析近十余年假体置换治疗19例肩胛骨恶性肿瘤的外科治疗适应证、操作要点和改进方法。结果 19例患者平均随访109个月．10例行边缘切除，9例行广泛切除和限制型肩胛骨假体置换手术；边缘切除和广泛切除后复发率分别为30％和11．11％；早期4例仿生型假体术后3例出现仿生肩峰外露和肩胛岗压迫性溃疡，二次翻修假体，MSTS功能评分53.3％；5例改良型肩胛骨假体置换手术后无假体相关并发症，MSTS功能评分70％。结论 限制性全肩胛骨假体置换手术能在切除恶性肿瘤后，最大限度重建了盂肱关节和肩胛骨胸廓间的肌肉群体功能，建立一个稳定的、无痛的肩关节；改良型假体置换术后假体近期并发症少．功能好于仿生型假体。     

螺旋CT三维关节分离重建在肩胛骨骨折术前评估中的价值

目的：探讨多层螺旋CT三维关节分离重建在肩胛骨骨折术前评估中的应用价值。方法：对我院2008年10月～2010年10月间52例经普通X线诊断的肩胛骨骨折患者,应用多层螺旋CT扫描肩关节获得原始轴位图像,在工作站对肩胛骨采用多平面重建（MPR）及容积再现技术（VR）三维重建,然后对VR图像通过关节分离去掉肱骨、肋骨、锁骨,保留肩胛骨。结果：52例肩胛骨骨折中,MPR发现骨折73处,其中肩胛骨体部骨折25处,肩胛颈骨折11处,盂缘骨折9处,盂窝骨折6处,肩峰骨折7处,肩胛冈骨折8处,喙突骨折7处。VR发现骨折62处,有8例关节盂、盂窝骨折及细小骨折未显示或显示不佳;多层螺旋CT三维关节分离重建得到的VR图像全部显示盂缘骨折及盂窝骨折15处。结论：螺旋CT三维关节分离重建图像能清晰、直观地显示肩胛骨骨折情况,对临床制定手术计划具有重要的指导意义。