CAJ | 학술논문

　　目的探讨手术治疗浮肩损伤的方法和疗效。方法2005年7月至2012年7月，我们经治浮肩损伤患者36例，均行锁定钢板内固定手术治疗。术前对后盂极角( GPA )进行了测量。结果左肩21例，右肩15例。交通伤24例，坠落伤5例，重物压砸伤3例，挤压伤4例。合并臂丛神经损伤2例，颅脑外伤3例，颈髓损伤1例，肋骨骨折、血气胸13例，合并其他部位多发骨折5例，肩胛伤神经挫伤1例。受伤至手术3～35天，平均7天。锁骨干骨折21例，肩锁关节脱位15例。肩胛骨解剖颈骨折7例，外科颈骨折17例，外科颈伴肩胛冈骨折6例，伴肩胛盂前部骨折1例，伴肩峰骨折4例，伴喙突骨折2例。Miller 分型， I 型7例，II 型17例，III 型7例，IV 型4例。V 型2例。术后随访3个月至2.5年，平均15个月。35例骨折全部愈合。1例经二期手术愈合。术前 GPA 平均15°，术后平均35°，骨折部位得到解剖复位。术后肩关节功能采用 Hardegger 标准评定，优17例，良14例，可5例，优良率86%。结论手术治疗浮肩损伤恢复了肩胛颈的解剖结构，恢复了肩关节上方悬吊结构，为早期肩关节功能锻炼提供了基础，有利于最大程度的恢复患肩功能。
　　목적탐토수술치료부견손상적방법화료효。방법2005년7월지2012년7월，아문경치부견손상환자36례，균행쇄정강판내고정수술치료。술전대후우겁각( GPA )진행료측량。결과좌견21례，우견15례。교통상24례，추락상5례，중물압잡상3례，제압상4례。합병비총신경손상2례，로뇌외상3례，경수손상1례，륵골골절、혈기흉13례，합병기타부위다발골절5례，견갑상신경좌상1례。수상지수술3～35천，평균7천。쇄골간골절21례，견쇄관절탈위15례。견갑골해부경골절7례，외과경골절17례，외과경반견갑강골절6례，반견갑우전부골절1례，반견봉골절4례，반훼돌골절2례。Miller 분형， I 형7례，II 형17례，III 형7례，IV 형4례。V 형2례。술후수방3개월지2.5년，평균15개월。35례골절전부유합。1례경이기수술유합。술전 GPA 평균15°，술후평균35°，골절부위득도해부복위。술후견관절공능채용 Hardegger 표준평정，우17례，량14례，가5례，우량솔86%。결론수술치료부견손상회복료견갑경적해부결구，회복료견관절상방현조결구，위조기견관절공능단련제공료기출，유리우최대정도적회복환견공능。
Objective To investigate the methods and effects of surgical treatment of floating shoulder injuries. Methods 36 patients with floating shoulder injuries were treated from July 2005 to July 2012. All patients underwent locking plate fixation. The glenopolar angle ( GPA ) was measured preoperatively and postoperatively. Results Injuries in the left shoulder occurred in 21 cases, and injuries in the right shoulder in 15 cases. There were 24 cases of traffic injuries, 5 cases of falling injuries, 3 cases of crash injuries of heavy weights, 4 cases of crush injuries, 2 cases of combined brachial plexus nerve injuries, 3 cases of craniocerebral trauma, 1 case of cervical spinal cord injuries, 13 cases of rib fractures and hemopneumothorax, 5 cases of combined multiple fractures in other parts and 1 case of scapular injuries and nerve contusion. The mean time from primary injury to operation was 7 days ( range;3-35 days ). There were 21 cases of fractures of the clavicle shaft, 15 cases of acromioclavicular joint dislocation, 7 cases of anatomical neck fractures of the scapula, 17 cases of surgical neck fractures, 6 cases of surgical neck fractures combined with fractures of the spina scapulae, 1 case of combined anterior scapular glenoid fractures, 4 cases of combined acromion fractures and 2 cases of combined coracoid fractures. According to Miller’s classification, there were 7 cases of type I, 17 cases of type II, 7 cases of type III, 4 cases of type IV and 2 cases of type V. All patients were followed up for a mean period of 15 months ( range;3-30 months ) postoperatively. Fracture healing was achieved in all patients, and which was finally achieved in 1 patient after the second-stage operation. Preoperatively the mean GPA was 15°, and 35° postoperatively. Anatomic reduction was achieved in all fractures. According to Hardegger’s evaluation of postoperative shoulder joint function, 17 patients showed excellent results, 14 good and 5 fair, and the excellent and good rate was 86%. Conclusions Surgical treatment of floating shoulder injuries can restore the anatomical structure of the scapular neck and the superior suspensory shoulder complex ( SSSC ), provide the basis for the functional exercise of shoulder joints in the early stage and promote the recovery of shoulder function as much as possible.