《肩胛骨骨折》PPT课件

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1、肩胛骨(Scapula)骨折的诊治戚剑AnatomyReview1.Borders1)medial(内侧缘)2)lateral(外侧缘)3)superior(上缘)coracoidprocess(喙突)scapularnotch(肩胛切迹)2.Angles1)superior(上角)2)inferior(下角)3)lateral(外侧角)glenoidcavity(关节盂)neckofscapula(肩胛颈)3.Surfaces1)Anteriorsubscapularfossa(肩胛下窝)2)Pos

2、teriorspineofscapula(肩胛冈)supraspinousfossa(冈上窝)infraspinousfossa(冈下窝)RAntviewRPostviewFunctionsoftheScapula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ShoulderEvaluation(Observation)ScapulohumeralRhythmMovementofscapular

3、elativetothehumerusInitial30degreesofglenohumeralabductiondoesnotincorporatescapularmotion(settingphase)30to90degreesthescapulaabductsandupwardlyrotates1degreeforevery2degreesofhumeralelevationAbove90degreesthescapulaandhumerusmovein1:1ratioIncidenceofS

4、capulaFractures1%ofallfractures3%ofinjuriestoshouldergirdle5%ofshoulderfracturesScapulaFractures-ClassificationBodyNeckGlenoidAcromionCoracoidSpineClassification稳定的关节外骨折——肩胛体，肩胛骨突，单纯肩胛颈不稳定的关节外骨折——肩胛颈合并骨突或锁骨骨折关节内骨折——肩盂的横行骨折，或大块盂缘骨折Zdravkovic-DamholtClass

5、ification肩胛体部骨折骨突部位的骨折肩胛骨的外上部骨折（肩胛颈和肩盂骨折）IdebergClassification盂缘骨折盂窝至肩胛体外缘骨折盂窝外上部分骨折盂窝中心至肩胛内缘的横行骨折Ⅱ、Ⅲ、Ⅳ组合损伤盂窝严重粉碎骨折EyresClassification喙突顶端或骺的损伤喙突中部骨折喙突基底骨折波及肩胛体上部的骨折延及肩盂的骨折DiagnosisHistorytypicallyhighenergyinjury(80-95%incidenceotherinjury)Mechanismoft

6、endirectbutcanbeindirectDiagnosisultimatelyradiographicRadiographs“Scapulatraumaseries”:APandLatofscapula,trueglenohumeralaxillaryviewCTscanningforcomplexinjurieswith3DreconstructionsStressAPprojectionifinjurytotheclavicular-scapularlinkagesuspected假性肩袖

7、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NonoperativeTreatment>90%scapularfracturesminimallydisplacedTreatmentinslingandswathewithgradualincreaseoffunctionaluseforfirst6weeksx-raysat2weekintervalsuntil6weeksNonoperativeTxContinuedAt6weeksosse

8、ousunionusuallypresentandsling/swathediscontinuedFullrecoverymaytake6monthsto1yearOperativeIndications1.Significantlydisplaced(5-10mm)fracturesofglenoidcavity(rimandfossa)2.Significantlydisplaced(10mmor40degreesrotation)fractures