探讨喙突骨折的治疗方法和效果
发布时间：2019-05-22 00:07
【摘要】：目的:主要研究各型喙突骨折的手术治疗效果,并对不同类型的喙突骨折的治疗方法进行分析比较,为临床进行喙突骨折的治疗方面提供理论依据与参考。材料及方法:本研究中回顾性分析了自2010年6月至2016年12月进行治疗的因不同原因导致或合并有喙突骨折的患者共15例,其中男性患者有10例,女性患者有3例;患者的年龄分布在28～51岁之间,平均37岁。根据受伤情况分类:车祸伤有7例,高处坠落伤有2例,重物砸伤有1例,跌伤有3例,其他原因有2例。其中11例患者合并有其他部位的复合伤。15例病例均患有喙突骨折,将其按喙突骨折的Eyres分型方法进行分类:ⅡB型有2例、ⅢA型有2例、ⅣA型1例、ⅤA型有7例、ⅤB型有3例。合并有肩锁关节脱位的病例共10例,按Rockwood分型方法分类:Ⅰ型有2例、Ⅱ型有2例、Ⅲ型有5例、Ⅳ型有1例。合并有锁骨骨折的患者共2例,按Craig分型方法分类:Ⅰ型有1例、ⅡA型有1例,2例锁骨骨折的患者均合并Rockwood Ⅰ型肩锁关节脱位。在进行治疗前根据损伤控制理论,对于合并有严重创伤的重症患者需首先处理危及生命的合并伤,以保证患者生命情况回归稳定,最后择期进行喙突骨折的切开复位内固定手术。术前常规行肩部X线检查、CT平扫和CT三维重建等影像学检查,了解喙突及肩胛盂的骨折情况。其中13例Eyres Ⅲ、Ⅳ、Ⅴ型喙突骨折患者均施行切开复位内固定术,2例Eyres Ⅱ型喙突骨折患者给予前臂悬吊固定保守治疗。合并有肩锁关节脱位的病例中,8例给予锁骨钩钢板固定,2例使用克氏针固定。手术的13例患者,术后均给予肩关节悬吊制动,定期随访,观察患者预后,最后引入Herscovici评分标准行肩关节术后功能评估。结果:15例患者均获得随访,随访时间为6～13个月,平均随访时间为10个月。手术的13例患者均无术后感染、伤口不愈合、神经血管压迫等症状,无骨延迟愈合、不愈合、畸形愈合等并发症,术后所有患者的喙突骨折均达到骨性愈合,喙突骨折的手术切口都是一级愈合。手术治疗的13例患者骨折线消失的平均时间为10.8周;保守治疗的2例EyresⅡ型骨折患者的愈合时间稍延长,平均11.0周。所有患者的骨性愈合时间平均10.8周。所有患者接受治疗后,进行末次复查肩功能Herscovici评分为12～16分,平均14.1分。结论:单纯喙突骨折比较少见,大多数因高能量创伤引起,因此遇到因高能撞击如车祸伤、高处坠落伤导致多发骨折的患者应注意是否伴有喙突骨折、肩锁关节脱位等,此类骨折往往伴随其他合并伤而容易漏诊,建议无法确诊时应行CT平扫和三维重建;在Eyres Ⅴ型喙突骨折中复位固定肩胛盂骨折时,沿三角肌胸大肌切口并显露肩关节囊有操作方便、暴露明显等优点;喙锁韧带完整的EyresⅤA型喙突骨折行手术治疗时可以先尝试复位肩锁关节脱位再进行喙突骨折的复位内固定,如此做可以减少移位的锁骨通过喙锁韧带对喙突游离骨块的牵拉,更易于喙突骨折的复位内固定;在治疗各类型的喙突骨折的过程中,我们发现切开复位内固定手术对治疗喙突骨折可以拥有比较满意的临床效果和预后。
[Abstract]:Objective: To study the surgical treatment effect of various kinds of coracoid fracture, and to compare the treatment methods of different types of coracoid fracture, and provide the theoretical basis and reference for the treatment of the coracoid fracture. Materials and Methods: A retrospective analysis of 15 patients with coracoid fractures due to different causes from June 2010 to December 2016, of which 10 were male,3 in female, and between 28 and 51 years, with an average of 37 years. According to the classification of injury,7 cases were injured in the car accident,2 cases were injured in the high place,1 case was injured by the heavy object,3 for the fall injury, and 2 for the other reasons. Of these,11 of them were combined with a compound wound in other parts.15 cases had a coracoid fracture, and it was classified according to the Etyres classification method of the coracoid fracture. There were 2 cases of type 鈪,2 cases of type 鈪,1 case of type IV A,7 cases of type V A and 3 cases of type 鈪，
本文编号：2482516
[Abstract]:Objective: To study the surgical treatment effect of various kinds of coracoid fracture, and to compare the treatment methods of different types of coracoid fracture, and provide the theoretical basis and reference for the treatment of the coracoid fracture. Materials and Methods: A retrospective analysis of 15 patients with coracoid fractures due to different causes from June 2010 to December 2016, of which 10 were male,3 in female, and between 28 and 51 years, with an average of 37 years. According to the classification of injury,7 cases were injured in the car accident,2 cases were injured in the high place,1 case was injured by the heavy object,3 for the fall injury, and 2 for the other reasons. Of these,11 of them were combined with a compound wound in other parts.15 cases had a coracoid fracture, and it was classified according to the Etyres classification method of the coracoid fracture. There were 2 cases of type 鈪,2 cases of type 鈪,1 case of type IV A,7 cases of type V A and 3 cases of type 鈪，
本文编号：2482516
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