The Effect Of Reconstruction Of Scapular Stability In The Surgical Treatment Of Floating Shoulder Injury

[Background]Floating Shoulder Injury(FSI)refers to injuries in two(or more)parts of the Superiror Shoulder Suspensory Complex(SSSC)-including distal clavicle,acromioclavicular joint,and shoulder lock Ligaments,acromions,scapular ligaments,shoulder blades,scapular necks,condylar processes,coracoclavicular ligaments,and bony pillars(middle clavicle)and bony pillars below(scapular ridge and lateral border of scapula)lead to shoulder joints Unstable.Although the incidence of FSI is low,accounting for only 0.1% of total body fractures,it is mostly caused by high-energy violence.The damage of the anatomy of the shoulder is complex,which brings certain difficulties to the treatment.At present,there are many controversies regarding the treatment of FSI.Edwards et al.believe that there is a stable FSI,conservative treatment can also get a relatively satisfactory prognosis,to avoid surgical complications.Most scholars believe that when FSI occurs,open reduction and internal fixation should be performed regardless of the injury.Herscovici and Hasiguchl et al.concluded that the reduction of the scapula can be avoided by avoiding the extra trauma caused by the surgery,and the postoperative recovery is good.Marku et al.believe that the reconstruction of the scapula at the same time as the treatment of the clavicle helps reduce the occurrence of malunion and promotes the recovery of shoulder function.This article compares the simple fixation of the clavicle and the fixation of the clavicle and scapula at the same time the surgical safety,early complications and long-term functional recovery,to explore the importance of stability of the scapula in the treatment of FSI,and provide theoretical basis for the clinical treatment of FSI.[Objective]To explore the importance of reconstruction of scapular stability in the treatment of floating shoulder injury(FSI).By comparing operative safety,early complications,and shoulder function recovery,between the patients who have the ability to reconstruction of the scapular stability and who do not have the reconstruction of the scapular stability.[Methods]Select 75 cases with the floating shoulder injury in department of orthopedics in our hospital between January 2008 and March 2017 as a comparative study.They were divided into the non reconstructive scapular group(group A)and the reconstructive scapular group(group B).Out of seventy five,40 patients(average age of 50.40±12.18 years old)treated by internal plate fixation of the fracture of the clavicle(group A),35 patients(average age of 49.14±11.63 years)treated by internal plate fixation of the fracture of the clavicle and the scapula(group B).By comparing the operation time of the two groups,the amount of bleeding and the time of X-ray exposure to analyze the surgical safety,and observing the early postoperative complications.After the 9-36 months period of follow-up,long-term shoulder joint function of the two groups was observed and compared,and the effect of the stability of the scapula on the long-term shoulder joint function was analyzed.[Results]B group of patients have both the operation time and amount of bleeding or intraoperative X-ray exposure time was greater than that of group A(P = 0.000 < 0.05),but there are 2 cases early postoperative complications occurred in group A,which includes,1 case of acromioclavicular joint dislocation and internal fixation failure in 1 case,B group of early postoperative complications incudes,1 cases of the incision infection.The average fracture healing time of the two groups was not significantly different(t=-0.730,P=0.467 > 0.05),and no cases of delayed union were found.The shoulder joint function of group B(Neer score =92.91 + 5.20)was better than that of group A(Neer score of =89.03 + 7.63),and the difference was statistically significant(P = 0.013 < 0.05).Its advantages were mainly reflected in the recovery of function and exercise range,but there was no significant difference between the two groups in the pain of shoulder joint and the restoration of anatomical structure.[Conclutions]In the surgical treatment of floating shoulders,although reconstructing the stability of the scapula takes longer to operate,leads to more surgical hemorrhage and radiation exposure,but it is more conducive to the recovery of long-term shoulder function,especially the range of motion.Functionally,there are advantages to improve the quality of life of patients.There are many methods and materials for surgical reconstruction of the scapula.Surgical procedures and surgical techniques are also relatively mature.The risk of postoperative complications is also greatly reduced compared with the early stage.Therefore,it is recommended that surgical reconstruction of the scapula can be a preferred treatment option when patients can tolerate surgery.