骨科英文书籍精读（59）｜肩胛骨骨折（1）
FRACTURES OF THE SCAPULA
Mechanisms of injury
The body of the scapula is fractured by a crushing force, which usually also fractures ribs and may dislocate the sternoclavicular joint. The neck of the scapula may be fractured by a blow or by a fall on the shoulder; the attached long head of triceps may drag the glenoid downwards and laterally. The coracoid process may fracture across its base or be avulsed at the tip. Fracture of the acromion is due to direct
force. Fracture of the glenoid fossa usually suggests a medially directed force (impaction of the joint) but may occur with dislocation of the shoulder.
Clinical features
The arm is held immobile and there may be severe bruising over the scapula or the chest wall. Because of the energy required to damage the scapula, fractures of the body of the scapula are often associated with severe injuries to the chest, brachial plexus, spine, abdomen and head. Careful neurological and vascular examinations are essential.
X-Ray
Scapular fractures can be difficult to define on plain x-rays because of the surrounding soft tissues. The films may reveal a comminuted fracture of the body of the scapula, or a fractured scapular neck with the outer fragment pulled downwards by the weight of the arm. Occasionally a crack is seen in the acromion or the coracoid process. CT is useful for demonstrating glenoid fractures or body fractures.
Classification
Fractures of the scapula are divided anatomically into scapular body, glenoid neck, glenoid fossa, acromion and coracoid processes. Scapular neck fractures are the most common. Further subdivisions are shown inTable 24.1.
---from 《Apley’s System of Orthopaedics and Fractures》P735-736
重点词汇整理：
SCAPULA /ˈskæpjələ/n. 肩胛；肩胛骨
sternoclavicular /,stə:nəuklə'vikjulə/adj. 胸锁的；胸骨锁骨的
glenoid /'glinɔɪd/n. 关节盂adj. 像浅窝的，有浅窝的；关节盂的
laterally /ˈlætərəli/adv. 旁边地
coracoid process 喙突 /'kɑrə,kɔɪd/n. 喙突；乌喙骨adj. 乌喙的；喙状的
avulse /ə'vʌls/v. 抽出；撕裂，撕脱
fossa /'fɔsə/n. [解剖] 凹；小窝
medial /ˈmiːdiəl/n. [语] 中间字母adj. 中间的；平均的；普通的
bruise/bruːz/n. 擦伤；挫伤；青肿
vt. 使受瘀伤；使受挫伤vi. 擦伤；受伤
brachial plexus 臂丛
abdomen/ˈæbdəmən/n. 腹部；下腹；腹腔
plain x-rays一般放射线检查
acromion /ə'kromɪən/n. [解剖] 肩峰
subdivision /,sʌbdɪ'vɪʒn/n. 细分；分部；供出卖而分成的小块土地
百度翻译：
肩胛骨骨折
损伤机制
肩胛骨的身体被挤压力折断，通常也会折断肋骨，并可能使胸锁关节脱位。肩胛骨的颈部可能会因击打或落在肩膀上而骨折；附着在三头肌上的长头可能会将肩胛骨向下和侧向拖拽。喙突可能在底部断裂或在尖端撕裂。肩峰骨折是由于直接武力。肩胛盂窝骨折通常提示有一个向内侧的力（关节的撞击），但也可能伴随着肩关节的脱位。
临床特征
手臂固定不动，肩胛骨或胸壁可能有严重瘀伤。由于损伤肩胛骨所需的能量，肩胛骨体部骨折常伴有胸部、臂丛神经、脊柱、腹部和头部的严重损伤。仔细的神经和血管检查是必要的。
X射线
由于周围的软组织，肩胛骨骨折在平片上很难确定。这些影像可能显示肩胛骨体粉碎性骨折，或肩胛颈骨折，外部碎片被手臂。偶尔在肩峰或喙突中可以看到裂缝。CT可用于显示关节盂骨折或身体骨折。
分类
肩胛骨骨折在解剖学上分为肩胛体、肩胛颈、肩胛窝、肩峰和喙突。肩胛颈骨折是最常见的。进一步细分见表24.1。