Objective: To investigate the effectiveness of double internal fixations of clavicle and scapula and intraoperative reduction of glenopolar angle in the treatment of floating shoulder injuries.
Methods: Between January 2010 and June 2019, 13 patients with floating shoulder injury were treated with double internal fixation of clavicle and scapula and intraoperative reduction of glenopolar angle. There were 11 males and 2 females with an average age of 48 years (range, 25-65 years). The causes of injury included falling from height in 2 cases, traffic accident injury in 3 cases, heavy object injury in 2 cases, and other injuries in 6 cases. There were 2 cases of Ⅰ-B-3 type, 1 case of Ⅰ-C-2 type, 1 case of Ⅰ-C-3 type, 3 cases of Ⅱ-B-2 type, 1 case of Ⅱ-B-3 type, 1 case of Ⅱ-B-4 type, 2 cases of Ⅱ-C-2 type, 1 case of Ⅱ-C-4 type, and 1 case of Ⅱ-D-3 type according to the classification of floating shoulder injury. All patients had unilateral clavicle fracture with scapular neck fracture, 1-4 superior shoulder suspensory complex (SSSC) injuries. The time from injury to operation was 7-17 days, with an average of 12 days. The glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, scapular glenoid up and down angle were measured before and after operation; Constant-Murly score and Herscovici score were used to evaluate the recovery of shoulder joint function.
Results: All incisions healed by first intention, and there was no early postoperative complications such as infection. All 13 cases were followed up 12-48 months, with an average of 25.2 months. Both the clavicle and the scapula had bone union, and the average healing time was 6 months and 4 months respectively. There were no complications such as nonunion, shoulder deformity, plate fracture or failure of internal fixation, acromion impingement syndrome, and frozen shoulder. At last follow-up, the glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, and scapular glenoid up and down angle were all corrected significantly ( P<0.05). The pain, function, activity, muscle strength scores, and total score in Constant-Murly score were significantly improved when compared with preoperative scores ( P<0.05). According to the Herscovici scoring standard, the shoulder joint function was evaluated as excellent in 8 cases, good in 3 cases, and fair in 2 cases. The excellent and good rate was 84.6%.
Conclusion: Double internal fixation of clavicle and scapula to stabilize SSSC and reduct glenopolar angle during operation is an effective method for treating the floating shoulder injury.
目的: 探讨采用锁骨及肩胛骨双重内固定并术中复位盂极角治疗浮肩损伤的临床疗效。.
方法: 2010 年 1 月—2019 年 6 月采用锁骨及肩胛骨双重内固定并术中复位盂极角治疗 13 例浮肩损伤患者。男 11 例，女 2 例；年龄 25～65 岁，平均 48 岁。致伤原因：高处坠落伤 2 例，交通事故伤 3 例，重物砸伤 2 例，其他伤 6 例。浮肩损伤分型：Ⅰ-B-3 型 2 例，Ⅰ-C-2 型 1 例，Ⅰ-C-3 型 1 例，Ⅱ-B-2 型 3 例，Ⅱ-B-3 型 1 例，Ⅱ-B-4 型 1 例，Ⅱ-C-2 型 2 例，Ⅱ-C-4 型 1 例，Ⅱ-D-3 型 1 例。均为单侧锁骨骨折伴肩胛颈骨折，肩关节悬吊复合体（superior shoulder suspensory complex，SSSC）损伤 1～4 处。受伤至手术时间 7～17 d，平均 12 d。手术前后测量盂极角、肩峰下间隙、肩胛盂前后倾斜角、肩胛盂上下倾斜角；采用 Constant-Murly 评分和 Herscovici 评分评价肩关节功能恢复情况。.
结果: 术后切口均Ⅰ期愈合，无感染等术后早期并发症发生。13 例均获随访，随访时间 12～48 个月，平均 25.2 个月。患者锁骨及肩胛骨均获骨性愈合，愈合时间分别为平均 6 个月和 4 个月。均未出现骨不连、肩关节畸形、钢板断裂或内固定失效、肩峰撞击综合征、冰冻肩等并发症。末次随访时，盂极角、肩峰下间隙、肩胛盂前后倾斜角和肩胛盂上下倾斜角均较术前明显纠正（ P<0.05）；Constant-Murly 评分中疼痛、活动度、日常功能、肌力评分及总分均较术前明显提高（ P<0.05）；根据 Herscovici 评分标准评价肩关节功能，获优 8 例、良 3 例、可 2 例，优良率 84.6%。.
结论: 采用锁骨及肩胛骨双重内固定稳定 SSSC 并术中复位盂极角治疗浮肩损伤可获得良好疗效。.
Keywords: Floating shoulder injury; clavicle; glenopolar angle; internal fixation; scapula; superior shoulder suspensory complex.