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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
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Nonoperative Treatment
>90% scapular fractures minimally displaced
Treatment in sling and swathe with gradual increase of functional use for first 6 weeks
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
“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 linctures
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Scapula Fractures - Classification
Body Neck Glenoid Acromion Coracoid Spine
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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
3. Double Disruptions of the superior suspensory shoulder complex（上方悬吊复 合体） with displacement of one or more elements
History typically high energy injury (8095% incidence other injury) Mechanism often direct but can be indirect Diagnosis ultimately radiographic
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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
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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
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Diagnosis
glenoid cavity (关节盂) neck of scapula (肩胛颈)
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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)
x-rays at 2 week intervals until 6 weeks
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Nonoperative Tx Continued
At 6 weeks osseous union usually present and sling/swathe discontinued
Full recovery may take 6 months to 1 year
III. 关节内骨折——肩盂的横行骨折，或大 块盂缘骨折
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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）
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Ideberg Classification
I. 盂缘骨折 II. 盂窝至肩胛体外缘
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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
肩胛骨(Scapula)骨折的诊治
戚剑
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Anatomy Review
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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)
every 2 degrees of humeral elevation – Above 90 degrees the scapula and humerus move in 1:1 ratio
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Incidence of Scapula Fractures
1% of all fractures
3% of injuries to shoulder girdle
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R
R
Ant view Post view
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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
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Shoulder Evaluation (Observation)