CAJ | 학술논문

目的总结肩关节上方悬吊复合体两部分以上损伤的分型及手术治疗方法.方法 2006年6月至2010年3月,治疗26例肩关节上方悬吊复合体两部分以上损伤患者,男18例,女8例;年龄16～80岁,平均42岁.其中锁骨骨折合并肩胛颈骨折9例(Ⅰ型),锁骨远端骨折或脱位伴喙锁韧带、肩锁关节损伤10例(Ⅱ型),锁骨远端骨折合并肩关节上方悬吊复合体其余部分损伤7例(Ⅲ型).伤后至手术时间为3～10 d,平均6.4 d.肩胛颈及肩胛盂骨折均以重建钢板及空心钉固定,肩峰骨折以重建钢板及空心钉固定,锁骨骨折以重建钢板或钩状钢板固定,喙突骨折以空心钉固定,所有韧带损伤均行一期修复.术后随访,监测骨折愈合情况并指导功能康复.骨折愈合后以Rowe及Constant-Mudey评分系统对术后疗效进行评价.结果患者均获得随访,随访时间12～32个月,平均18.7个月.骨折愈合时间6～12周,平均8.2周.术后无一例出现肩峰下撞击征等并发症.患者肩关节均自觉处于稳定状态.2例患者出现三角肌肌力下降,3例出现肩部疲劳感及酸痛感.Rowe评分为71～97分,平均89.7分,其中优18例、良5例、可3例;Constant-Murley评分为70～100分,平均92.4分,其中优16例、良6例、可4例.结论肩关节上方悬吊复合体两部分以上损伤分为三型,可采用重建钢板及空心钉固定进行治疗.
목적 총결견관절상방현조복합체량부분이상손상적분형급수술치료방법.방법 2006년6월지2010년3월,치료26례견관절상방현조복합체량부분이상손상환자,남18례,녀8례;년령16～80세,평균42세.기중쇄골골절합병견갑경골절9례(Ⅰ형),쇄골원단골절혹탈위반훼쇄인대、견쇄관절손상10례(Ⅱ형),쇄골원단골절합병견관절상방현조복합체기여부분손상7례(Ⅲ형).상후지수술시간위3～10 d,평균6.4 d.견갑경급견갑우골절균이중건강판급공심정고정,견봉골절이중건강판급공심정고정,쇄골골절이중건강판혹구상강판고정,훼돌골절이공심정고정,소유인대손상균행일기수복.술후수방,감측골절유합정황병지도공능강복.골절유합후이Rowe급Constant-Mudey평분계통대술후료효진행평개.결과 환자균획득수방,수방시간12～32개월,평균18.7개월.골절유합시간6～12주,평균8.2주.술후무일례출현견봉하당격정등병발증.환자견관절균자각처우은정상태.2례환자출현삼각기기력하강,3례출현견부피로감급산통감.Rowe평분위71～97분,평균89.7분,기중우18례、량5례、가3례;Constant-Murley평분위70～100분,평균92.4분,기중우16례、량6례、가4례.결론 견관절상방현조복합체량부분이상손상분위삼형,가채용중건강판급공심정고정진행치료.
Objective To summarize the classification and surgical treatment of double or above disruptions of the superior shoulder suspensory complex(SSSC)retrospectively.Methods From June 2006to March 2010,26 consecutive patients with double or above disruptions of the SSSC were treated and entered in the study,including 18 males and 8 females with an average age of 42 years(range,16-80).All patients received surgical treatment,these included clavicle fracture and scapular neck fracture in 9 cases (type Ⅰ),distal clavicle fracture or dislocation and coracoclavicular ligament and acromioclavicular joint injury in 10(type Ⅱ),distal clavicle fracture and other injuries in the SSSC in 7(type Ⅲ).The duration from injury to surgery was 6.4 days(range,3-10).Scapular neck fracture and scapular area dishes fracture were fixed with reconstructive plate and canulated screws,acromial fracture was treated with reconstructive plate and canulated screws,clavicle fracture was fixed with reconstructive plate or hook plate,coracoid fracture was fixed with canulated screw.All patients were treated with primary repair for ligament injuries.The surgery effect was assessed with Rowe and Constan-Murley systems after the fractures reunion.Results All patients were successfully followed up,and the average time was 18.7 months(range,12-32).Fractures were healed with an average of 8.2 weeks(range,6-12 weeks).There was no inferior shoulder knocking syndrome after surgery.Patients all felt shoulder in a stable status.Two patients appeared deltoid muscle power decline,3 appeared shoulder fatigue and aching pain.The average score was 89.7(range,71-97)according to the Rowe system.Eighteen cases were grade as excellent,5 as good,and 3 as fair.The average score was 92.4(range,70-100)according to the Constant-Murley system.Sixteen cases were grade as excellent,6 as good,and 4 as fair.Conclusion Double or above disruptions of the SSSC can be classified into three types,and surgical treatment with constructive plate and canulated screws for them is a good option.