骨科英文书籍精读（60）｜肩胛骨骨折（2）
Treatment
Body fractures Surgery is not necessary. The patient wears a sling for comfort, and from the start practises active exercises to the shoulder, elbow and fingers.
Isolated glenoid neck fractures The fracture is usually impacted and the glenoid surface is intact. A sling is worn for comfort and early exercises are begun.
Intra-articular fractures Type I glenoid fractures, if displaced, may result in instability of the shoulder. If the fragment involves more than a third of the glenoid surface and is displaced by more than 5 mm surgical fixation should be considered. Anterior rim fractures are approached through a delto-pectoral incision and posterior rim fractures through the posterior approach. Type II fractures are associated with inferior subluxation of the head of the humerus and require open reduction and internal fixation. Types III, IV, V and VI fractures have poorly defined indications for surgery. Generally speaking, if the head is centred on the major portion of the glenoid and the shoulder is stable a non-operative approach is adopted. Comminuted fractures of the glenoid fossa are likelyto lead to osteoarthritis in the longer term.
Fractures of the acromion Undisplaced fractures are treated non-operatively. Only Type III acromial fractures, in which the subacromial space is reduced, require operative intervention to restore the anatomy.
Fractures of the coracoid process Fractures distal to the coracoacromial ligaments do not result in serious anatomical displacement; those proximal to the ligaments are usually associated with acromioclavicular separations and may need operative treatment.
Combined fractures Whereas an isolated fracture of the glenoid neck is stable, if there is an associated fracture of the clavicle or disruption of the acromioclavicular ligament the glenoid mass may become markedly displaced giving rise to a ‘floating shoulder’ (Williams et al, 2001). Diagnosis can be difficult and may require advanced imaging and three-dimensional reconstructions. At least one of the injuries (and sometimes both) will need operative fixation before the fragments are stabilized.
---from 《Apley’s System of Orthopaedics and Fractures》P736-737
重点词汇整理：
sling吊带
the fragment involves more than a third of the glenoid surface and is displaced by more than 5 mm 骨折碎片占关节盂表面的三分之一以上，移位超过5毫米
rim /rɪm/n. 边，边缘
incision /ɪnˈsɪʒn/n. 切口；入路；雕刻，切割；切开
posterior approach后方入路
subluxation /,sʌblʌk'seiʃən/n. [外科] 半脱位；不全脱位
Comminuted fractures of the glenoid fossa are likelyto lead to osteoarthritis in the longer term.从长期来看，肩胛窝粉碎性骨折有可能导致骨关节炎。
acromion /ə'kromɪən/n. [解剖] 肩峰
subacromial 肩峰下的
coracoid process喙突
coracoacromial ligaments喙肩韧带
proximal /ˈprɑːksɪməl/adj. 近端的；近源的；（牙齿）近侧的
acromioclavicular/ə,krəumiəuklə'vikjulə/adj. 肩锁的
floating shoulder漂浮肩
three-dimensional reconstructions三维重建/ˌθriː daɪˈmenʃənl,ˌθriː dɪˈmenʃənl/
百度翻译：
治疗
身体骨折不需要手术。病人戴着吊带以获得舒适感，从一开始就练习肩部、肘部和手指的主动运动。
孤立性肩胛盂颈骨折骨折通常受到撞击，肩胛盂表面完整。为了舒适，人们戴上吊带，开始了早期的锻炼。
关节内骨折I型关节盂骨折，如果移位，可能导致肩关节不稳定。如果碎片累及超过三分之一的关节盂表面，并被5毫米以上的手术固定所移位，则应考虑。前边缘骨折通过delto胸廓切口入路，后边缘骨折通过后入路入路。Ⅱ型骨折合并肱骨头部下半脱位，需切开复位内固定。III、IV、V和VI型骨折的手术指征不明确。一般来说，如果头部位于关节盂的主要部位，肩部稳定，则采用非手术入路。关节盂窝粉碎性骨折从长远来看会导致骨关节炎。
肩锁关节未移位骨折采用非手术治疗。只有III型肩峰骨折，肩峰下间隙缩小，需要手术干预来恢复解剖结构。
喙突骨折喙肩胛韧带远端骨折不会导致严重的解剖移位；韧带近端骨折通常与肩锁关节分离有关，可能需要手术治疗。
合并骨折——虽然单独的肩胛骨颈骨折是稳定的，但如果锁骨有相关骨折或肩锁韧带断裂，肩胛骨块可能会明显移位，形成“浮肩”（Williams等人，2001）。诊断可能很困难，可能需要先进的成像和三维重建。在骨折块稳定之前，至少有一处（有时两处）需要手术固定。