三维重建结合钛板或拉力螺钉微创修复复杂肩胛骨骨折  

Three-dimensional reconstruction combined with minimally invasive titanium plate or lag screw in the repair of complex scapular fractures

作　　者：李学金[1] 许杰[1] 刘颖[1] 裴宝岩[1] 李群[1] 姜永冲[1] 

机构地区：[1]秦皇岛市第一医院骨科,河北省秦皇岛市066000

出　　处：《中国组织工程研究》2014年第26期4142-4147,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:复杂肩胛骨骨折多采用植入物内固定治疗,标准的内固定入路(Judet入路)切口长,创伤较大。随着螺旋CT及三维重建技术的应用,使得临床医师可在植入物内固定前设计微创切口并完成内固定治疗,减少创伤,提高修复效果。目的:观察三维重建设计结合重建钛板或拉力螺钉微创内固定修复复杂肩胛骨骨折的效果。方法:纳入2007年2月至2012年1月秦皇岛市第一医院骨科收治的33例复杂肩胛骨骨折患者,植入物内固定前进行CT三维重建扫描,明确需要复位及内固定的部位,依此设计微创植入物内固定切口,减少皮肤、皮下组织及肌肉的剥离,进行复位,并应用重建钛板及/或拉力螺钉内固定。结果与结论:33例患者手术时间90-130 min,术中出血300-400 mL,骨折全部愈合,愈合时间为2-4个月。植入物内固定后随访12-24个月,根据Hardegger标准评价肩关节功能,优17例,良12例,可3例,差1例,优良率为88%。提示三维重建设计组合小切口微创修复复杂肩胛骨骨折,能够以较小的创伤完成骨折的满意复位及植入物内固定,获得良好的修复效果。BACKGROUND：Complex scapular fractures were mainly treated by implant fixation. Standard fixation approach （Judet approach） had long incision and big trauma. With the application of spiral CT and three-dimensional reconstruction, minimal y invasive incision could be designed before implant fixation, and then fixation could be finished by physicians. Thus, trauma was reduced and repair effect was elevated. OBJECTIVE：To observe the effects of the three-dimensional reconstruction design combined with titanium plate reconstruction or lag screw for treatment of scapular fractures. METHODS：From February 2007 to January 2012, 33 cases of scapular fractures were enrol ed from Department of Orthopedics, No. 1 Hospital of Qinhuangdao in China. They were scanned by three dimensional reconstruction of CT before implant fixation to identify the regions needed to be repositioned and fixed. Thus, minimal y invasive incision of implant fixation was designed. The dissection of skin, subcutaneous tissue and muscle was reduced. Reposition was performed. Titanium plate and/or lag screw were used for fixation. RESULTS AND CONCLUSION：The operation lasted for 90-130 minutes in 33 patients, with intraoperative blood loss for 300-400 mL. Fracture was total y healed, and the healing time was 2-4 months. The fol ow up lasted for 12-24 months. According to Hardegger standard, there were excellent in 17 cases, good in 12 cases, average in 3 cases and poor in 1 case, with an excellent and good rate of 88%. These results suggested that three-dimensional reconstruction design combined with minimal y invasive incision treatment for scapular fractures showed fewer traumas, can complete the satisfactory fracture reduction and implant fixation, and obtain good repair effect.

关 键 词：植入物 骨植入物 肩胛骨骨折 内固定 三维重建 微创 

分 类 号：R318[医药卫生—生物医学工程]