肩胛骨骨折 PPT

• The acromial process has four basic functions: • 1. It provides one side of the acromioclavicular articulation. • 2. It serves as a point of attachment for various
• Nonunion of a scapular body fracture requiring surgical management has been described.
• Nordqvist and Petersson报道：当肩胛骨骨折 移位大于1cm时，7例患者中仅有3例患者恢 复满意；当移位小于1cm时，34例患者中29 例恢复满意。
• Fractures of the skull are found in approximately 25% of patients, cerebral contusions in 10% to 40%, central neurologitures in 11%, major vascular injuries in 11%, and injuries that result in splenectomy in 8%.
• Fractures of the scapular body and spine, as well as insignificantly displaced fractures of the glenoid, acromial, and coracoid processes, are managed nonoperatively.
• Bowen and colleagues reported a case of a significantly angulated greenstick fracture of the scapular body that required a closed reduction.
• On rare occasions, malunion of a scapular body fracture can result in scapulothoracic pain and crepitus requiring surgical exposure of its ventral surface and removal of the responsible bony prominence or prominences.
• The literature does mention a fracture of the scapular body with a lateral spike entering the glenohumeral joint as an indication (albeit extremely uncommon) for surgical management, and a similar recommendation was made in two cases involving patients with fractures of the scapular body and intrathoracic penetration by one of the fragments.
• 当肩胛骨骨折碎片向下后方移位，建议手 术治疗，切除碎片。
Isolated Acromial Fractures
• The acromial process is formed from two ossification centers: one for its most anterior end and one for its posterolateral tip (its base is actually an extension of the scapular body and spine).
骨折分型
• Zdravkovic和Damholt肩胛骨骨折分型
• Ideberg关节盂分型 • Kuhn的肩峰骨折分型 • Eyres喙突骨折分型
Fractures of the Scapular Body
• The vast majority of fractures of the scapular body and insignificantly displaced fractures (> 90% of glenoid, coracoid, acromial, and avulsion fractures) are managed nonoperatively.
• Harris发现100列肩胛骨骨折病人中仅有57%的骨折可在 胸片上识别
受伤机制
• 外展上肢轴向负荷的间接损伤（肩胛颈-关 节盂，关节内）
• 直接打击或身体跌倒 • 直接作用于肩峰喙突的创伤 • 肌肉或韧带的牵拉
影像学检查
• 肩胛骨前后位(负重/正常)和腋窝位，或侧 位X线检查。
• 肩关节三维CT检查
肩胛骨骨折 scapula fracture
• 流行病学 • 受伤机制及影像学检查 • 骨折分型及治疗 • 解剖 • 手术入路
Epidemiology
Epidemiology
• 25% to 45% of patients have accompanying rib fractures, 15% to 40% have fractures of the clavicle, 15% to 55% have pulmonary injuries (e.g., hemopneumotho-rax, pulmonary contusion), 12% have humeral fractures, and 5% to 10% sustain injuries to the brachial plexus and peripheral nerves.