肩胛骨骨折PPT课件
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4
R
R
Ant view Post view
5
6
7
Functions of the Scapula
肩胛骨对稳定上肢及发挥上肢功能起重要 作用 肩胛骨主要通过肌肉与躯干形成软组织连 接，因此肩胛骨的稳定主要由肌肉连接来 完成 上臂上举时1/3的活动发生于肩胛胸壁间
8
Shoulder Evaluation (Observation)
x-rays at 2 week intervals until 6 weeks
19
Nonoperative Tx Continued
At 6 weeks osseous union usually present and sling/swathe discontinued
Full recovery may take 6 months to 1 year
History typically high energy injury (8095% incidence other injury) Mechanism often direct but can be indirect Diagnosis ultimately radiographic
16
Radiographs
骨折 III. 盂窝外上部分骨折 IV. 盂窝中心至肩胛内
缘的横行骨折 V. Ⅱ、Ⅲ、Ⅳ组合损
伤 VI. 盂窝严重粉碎骨折
14
Eyres Classification
I. 喙突顶端或骺的损伤 II. 喙突中部骨折 III. 喙突基底骨折 IV. 波及肩胛体上部的骨折 V. 延及肩盂的骨折
15
Diagnosis
17
假性肩袖损伤体征 喙突骨折和体部骨折，深吸气时，疼痛加剧 肩胛颈和肩峰骨折时，肩外形变扁 注意检查肋骨、脊柱和胸部损伤
18
Nonoperative Treatment
>90% scapular fractures minimally displaced
Treatment in sling and swathe with gradual increase of functional use for first 6 weeks
“Scapula trauma series”: AP and Lat of scapula, true glenohumeral axillary view
CT scanning for complex injuries with 3D reconstructions
Stress AP projection if injury to the clavicular-scapular linkage suspected
20
Operative Indications
1. Significantly displaced (5-10mm) fractures of glenoid cavity (rim and fossa)
2. Significantly displaced (10mm or 40 degrees rotation) fractures of the glenoid neck
Scapulohumeral Rhythm
– Movement of scapula relative to the humerus – Initial 30 degrees of glenohumeral abduction does not incorporate
scapular motion (setting phase) – 30 to 90 degrees the scapula abducts and upwardly rotates 1 degree for
glenoid cavity (关节盂) neck of scapula (肩胛颈)
3
3. Surfaces
1) Anterior subscapular fossa(肩胛下窝)
2) Posterior spine of scapula (肩胛冈) supraspinous fossa (冈上窝) infraspinous fossa (冈下窝)
3. Double Disruptions of the superior suspensory shoulder complex（上方悬吊复 合体） with displacement of one or more elements
肩胛骨(Scapula)骨折的诊治
戚剑
1
Anatomy Review
2
1. Borders
1) medial (内侧缘) 2) lateral (外侧缘) 3) superior (上缘)
coracoid process (喙突) scapular notch (肩胛切迹)
2. Angles
1) superior (上角) 2) inferior (下角) 3) lateral (外侧角)
5% of shoulder fractures
10
Scapula Fractures - Classification
Body Neck Glenoid Acromion Coracoid Spine
11
Classification
I. 稳定的关节外骨折——肩胛体，肩胛骨 突，单纯肩胛颈
II. 不稳定的关节外骨折——肩胛颈合并骨 突或锁骨骨折
III. 关节内骨折——肩盂的横行骨折，或大 块盂缘骨折
12
Zdravkovic-Damholt Classification
I. 肩胛体部骨折 II. 骨突部位的骨折 III. 肩胛骨的外上部骨折（肩胛颈和肩盂骨
折）
13
Fra Baidu bibliotek
Ideberg Classification
I. 盂缘骨折 II. 盂窝至肩胛体外缘
every 2 degrees of humeral elevation – Above 90 degrees the scapula and humerus move in 1:1 ratio
9
Incidence of Scapula Fractures
1% of all fractures
3% of injuries to shoulder girdle
R
R
Ant view Post view
5
6
7
Functions of the Scapula
肩胛骨对稳定上肢及发挥上肢功能起重要 作用 肩胛骨主要通过肌肉与躯干形成软组织连 接，因此肩胛骨的稳定主要由肌肉连接来 完成 上臂上举时1/3的活动发生于肩胛胸壁间
8
Shoulder Evaluation (Observation)
x-rays at 2 week intervals until 6 weeks
19
Nonoperative Tx Continued
At 6 weeks osseous union usually present and sling/swathe discontinued
Full recovery may take 6 months to 1 year
History typically high energy injury (8095% incidence other injury) Mechanism often direct but can be indirect Diagnosis ultimately radiographic
16
Radiographs
骨折 III. 盂窝外上部分骨折 IV. 盂窝中心至肩胛内
缘的横行骨折 V. Ⅱ、Ⅲ、Ⅳ组合损
伤 VI. 盂窝严重粉碎骨折
14
Eyres Classification
I. 喙突顶端或骺的损伤 II. 喙突中部骨折 III. 喙突基底骨折 IV. 波及肩胛体上部的骨折 V. 延及肩盂的骨折
15
Diagnosis
17
假性肩袖损伤体征 喙突骨折和体部骨折，深吸气时，疼痛加剧 肩胛颈和肩峰骨折时，肩外形变扁 注意检查肋骨、脊柱和胸部损伤
18
Nonoperative Treatment
>90% scapular fractures minimally displaced
Treatment in sling and swathe with gradual increase of functional use for first 6 weeks
“Scapula trauma series”: AP and Lat of scapula, true glenohumeral axillary view
CT scanning for complex injuries with 3D reconstructions
Stress AP projection if injury to the clavicular-scapular linkage suspected
20
Operative Indications
1. Significantly displaced (5-10mm) fractures of glenoid cavity (rim and fossa)
2. Significantly displaced (10mm or 40 degrees rotation) fractures of the glenoid neck
Scapulohumeral Rhythm
– Movement of scapula relative to the humerus – Initial 30 degrees of glenohumeral abduction does not incorporate
scapular motion (setting phase) – 30 to 90 degrees the scapula abducts and upwardly rotates 1 degree for
glenoid cavity (关节盂) neck of scapula (肩胛颈)
3
3. Surfaces
1) Anterior subscapular fossa(肩胛下窝)
2) Posterior spine of scapula (肩胛冈) supraspinous fossa (冈上窝) infraspinous fossa (冈下窝)
3. Double Disruptions of the superior suspensory shoulder complex（上方悬吊复 合体） with displacement of one or more elements
肩胛骨(Scapula)骨折的诊治
戚剑
1
Anatomy Review
2
1. Borders
1) medial (内侧缘) 2) lateral (外侧缘) 3) superior (上缘)
coracoid process (喙突) scapular notch (肩胛切迹)
2. Angles
1) superior (上角) 2) inferior (下角) 3) lateral (外侧角)
5% of shoulder fractures
10
Scapula Fractures - Classification
Body Neck Glenoid Acromion Coracoid Spine
11
Classification
I. 稳定的关节外骨折——肩胛体，肩胛骨 突，单纯肩胛颈
II. 不稳定的关节外骨折——肩胛颈合并骨 突或锁骨骨折
III. 关节内骨折——肩盂的横行骨折，或大 块盂缘骨折
12
Zdravkovic-Damholt Classification
I. 肩胛体部骨折 II. 骨突部位的骨折 III. 肩胛骨的外上部骨折（肩胛颈和肩盂骨
折）
13
Fra Baidu bibliotek
Ideberg Classification
I. 盂缘骨折 II. 盂窝至肩胛体外缘
every 2 degrees of humeral elevation – Above 90 degrees the scapula and humerus move in 1:1 ratio
9
Incidence of Scapula Fractures
1% of all fractures
3% of injuries to shoulder girdle