肩胛骨骨折（英文）课件

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1、ScapulaFracturesThomasP.Goss,MDRobertV.Cantu,MDUniversityofMassachusettsMedicalCenterScapulothoracicDissociationAndrewH.Schmidt,MDCreatedMarch2004Outline1.IncidenceandMechanisms2.DiagnosisandNonoperativeTreatment3.FracturesoftheGlenoidProcess4.IsolatedFracturesoftheCor

2、acoidProcessOutlineContinued5.IsolatedFracturesoftheAcromialProcess6.DoubleDisruptionsoftheSuperiorShoulderSuspensoryComplex7.ScapulothoracicDissociation8.ComplicationsIncidenceofScapulaFractures1%ofallfractures3%ofinjuriestoshouldergirdle5%ofshoulderfracturesLocationof

3、ScapulaFracturesDiagnosisHistorytypicallyhighenergyinjury(80-95%incidenceotherinjury)MechanismoftendirectbutcanbeindirectDiagnosisultimatelyradiographicRadiographs“Scapulatraumaseries”:APandLatofscapula,trueglenohumeralaxillaryviewCTscanningforcomplexinjurieswith3Drecon

4、structionsStressAPprojectionifinjurytotheclavicular-scapularlinkagesuspectedNonoperativeTreatment>90%scapularfracturesminimallydisplacedTreatmentinslingandswathewithgradualincreaseoffunctionaluseforfirst6weeksx-raysat2weekintervalsuntil6weeksNonoperativeTxContinuedAt6we

5、eksosseousunionusuallypresentandsling/swathediscontinuedFullrecoverymaytake6monthsto1yearOperativeIndications1.Significantlydisplaced(5-10mm)fracturesofglenoidcavity(rimandfossa)2.Significantlydisplaced(10mmor40degreesrotation)fracturesoftheglenoidneck3.DoubleDisruption

6、softhesuperiorsuspensoryshouldercomplexwithdisplacementofoneormoreelementsGlenoidProcessGlenoidprocessincludesglenoidcavity(rimandfossa)andglenoidneckFracturesoftheGlenoidCavity(RimandFossa)10%ofscapulafracturesofwhichnomorethan10%aresignificantlydisplacedClassification

7、GlenoidCavityFracturesIa=anteriorrimfractureIb=posteriorrimfractureClassificationGlenoidCavityFracturesII=fracturelinethroughglenoidfossaexitingatlateralborderofscapulaClassificationGlenoidCavityFracturesIII=fracturelinethroughglenoidfossaexitingatsuperiorborderofthesca

8、pulaClassificationGlenoidCavityFracturesIV=fracturelinethroughglenoidfossaexitingatthemedialborderofthescapula