后侧入路微创内固定治疗不稳定肩胛骨骨折的疗效  

Clinical efficacy of internal fixation through posterior minimally invasive approach for treatment of unstable scapula fractures

作　　者：吴义刚[1] 李银山[2] 吴鹏[1] 张财[1] 庞建忠 吕全[1] Wu Yigang , Li Yinshan, Wu Peng, Zhang Cai, Pang Jianzhong, Lyu Quan.(Department of Orthopedics, Second People＇ s Hospital of Shizuishan, Shizuishan 753000, Chin)

机构地区：[1]石嘴山市第二人民医院骨科,宁夏回族自治区石嘴山市753000 [2]宁夏医科大学第一附属医院骨科

出　　处：《中华创伤杂志》2018年第5期415-419,共5页Chinese Journal of Trauma

摘　　要：目的 探讨后侧入路微创内固定治疗不稳定肩胛骨骨折的临床疗效. 方法 采用回顾性病例对照研究分析2011年5月-2016年8月收治的36例不稳定肩胛骨骨折患者的临床资料,其中男30例,女6例;年龄46 ～ 64岁,平均51.5岁.根据Hardegger分型：肩胛体部骨折18例,肩胛颈骨折14例,肩胛盂骨折4例.根据手术方式分为A组（24例,采用后侧入路微创切开复位内固定）和B组（12例,采用传统Judet入路切开复位内固定）.比较两组手术切口长度、手术时间、术中出血量、骨折愈合时间、Hardegger肩关节功能评分及并发症发生情况. 结果 36例患者获随访6～ 24个月,平均18个月.手术切口总长度A组为（12.50 ±4.50） cm,B组为（27.95±5.20） cm（P＜0.05）;手术时间A组为（86.5±11.5）min,B组为（120.6±10.9） min（P＜0.05）;术中出血量A组为（200.0± 20.0） ml,B组为（420.0±20.0） ml（P ＜0.05）;骨折愈合时间A组为（10.0±1.0）周,B组为（12.0±1.5）周（P＜0.05）,A组均优于B组.根据Hardegger肩关节功能评分标准：A组优15例,良6例,可2例,差0例,优良率为91％;B组优6例,良3例,可2例,差1例,优良率为75％（P＜0.05）.A组未出现并发症.B组出现术区血肿、切口不愈合各1例,经引流换药切口愈合;肩胛上神经损伤1例,经治疗好转.B组并发症发生率（25％）高于A组（0）（P＜0.05）.两组均无内固定物断裂或骨折不愈合情况. 结论 与传统Judet入路比较,后侧入路微创内固定治疗不稳定肩胛骨骨折具有创伤小、功能恢复快、并发症少等优点.Objective To investigate the clinical efficacy of internal fixation through posterior minimally invasive approach in treating unstable scapula fractures.Methods A retrospective case control study was conducted on the clinical data of 36 patients with scapular fractures admitted between May 2011 and August 2016.There were 30 males and six females,with average age of 51.5 years （range,46-64 years）.According to Hardegger classification,there were 18 patients with scapular body fracture,14 with scapular neck fracture,and four with glenoidal fracture.According to operation method,the patients were divided into Group A （n =24） which adopted internal fixation through posterior minimally invasive approach and Group B （n =12） which adopted the conventional Judet approach for internal fixation.The incision length,operation time,intraoperative bleeding,fracture healing time,Hardegger standard of clinical effects,and complications in two groups were compared.Results All patients were followed up for average 18 months （range,6-24 months）.The total length of surgical incision was （12.50 ± 4.50） cm in Group A and （27.95 ± 5.20） cm in Group B （P 〈 0.05）;the operation time was （86.5 ± 1 1.5） minutes in Group A and （120.6 ± 10.9） minutes in Group B （P 〈 0.05）;the intraoperative bleeding was （200.0 ± 20.0）ml in Group A and （420.0 ± 20.0）ml in Group B （P 〈 0.05）;fracture healing time was （10.0 ± 1.0） weeks in Group A （12.0 ± 1.5） weeks in Group B （P 〈 0.05）.According to Hardegger standard,in Group A,15 patients were excellent,six good,and two fair,with an excellent and good rate of 91%;while in Group B,six patients were excellent,three good,two fair,and one poor,with an excellent and good rate of 75% （P 〈 0.05）.No complications were observed in Group A.In Group B,one patient with hematoma and one patient with nonunion of incision area were observed,both of which recovered after drainage and dressing change.One patient with superior scapular nerve i

关 键 词：肩胛骨 骨折固定术 内 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]