浮肩损伤

目的探讨浮肩损伤（floating shoulder injuries,FSI）的临床特征及治疗方法.方法回顾分析1999年6月至2005年6月收治的36例FSI的临床资料,其中肩胛颈骨折合并同侧锁骨骨折31例、肩锁关节脱位5例.患者均有不同程度的合并损伤,其中肋骨骨折、血气胸和（或）肺挫伤占88.9%.伤后至手术时间为3～43 d,平均9.6 d.术中首先复位固定锁骨骨折或肩锁关节脱位,然后采用改良Judet后方入路处理肩胛颈骨折.肩胛颈骨折合并锁骨骨折或肩锁关节脱位行一期内固定33例,术中仅固定锁骨骨折3例.结果术后随访6～69个月,平均19.7个月.肩胛颈骨折在目标区上均获解剖复位.根据Constant和Murley的疗效标准,术后肩关节功能评分为9～100分,平均81.3分,中位数为93%.按照Herscovici的疗效标准,优25例（69.4%）,良6例（16.7%）,可4例（11.1%）,差1例（2.8%）,疗效优良率为86.1%.术后复发血气胸1例,肩关节外展受限、肩峰下间隙疼痛3例,迟发性肩胛上神经损伤1例,肩关节不稳定继发创伤性关节炎1例.结论FSI使肩胛颈的解剖结构及其上方悬吊装置受到双重破坏,非手术治疗难以纠正不稳定型FSI的三维移位,早期切开复位内固定可取得满意疗效.

The floating shoulder injuries

Objective To explore the clinical features and operative treatment of floating shoulder injuries. Methods The clinical data of 36 patients with floating shoulder injuries that had been admitted to our hospital from June 1999 to June 2005 were retrospectively analyzed. The scapular neck fractures associated with clavicle fractures were in 31 cases and acromioclavicular joint dislocation in 5 cases. All cases were accompanied by associated injuries, in which rib fractures combined hemopneumothorax and/or lung contusion was 88.9%. The mean time from primary injury to the fracture operation was 9.6 days (range, 3 to 43 days). The clavicle fractures or acromioclavicular joint dislocation were dealt with firstly, then scapular neck fractures treated through modified Judet posterior approach. Thirty-three cases received internal fixation with both injuries of scapular neck and clavicle or acromioclavicular joint and 3 cases received internal fixation only in clavicle shaft. Results All fractures had been restored anatomical reduction in the target site. The mean followed up time was 19.7 months (range, 6 to 69 months). According to Constant and Murley's evaluation, the median score of functional results was 93% (mean 81.3%, range from 9% to 100%). Based on Herscovici's evaluation, 25 (69.4%) cases showed excellent results, 6 (16.7) good, 4 (11.1%) fair, and 1 (2.8%) poor. The recurrence of primary hemopneumothorax was found in 1 case, shoulder joint abduction weakness and subacromial space pain in 3 cases, delayed lesion of suprascapular nerve in 1 case, and posttraumatic shoulder joint instability secondary to arthritis in 1 case postoperation. Conclusion The double injuries with scapular neck and their suspensory device of clavicular shaft or acromioclavicular joint in floating shoulder injuries can hardly be corrected and reduced in three dimensional displacement of distal fracture unit without operation. It is an effective way for such unstable injuries to get good results after open reduction and internal fixation in early stage.