采用改良Judet入路治疗肩胛盂骨折的疗效分析  

Treatment of scapular glenoid fractures via the modified Judet approach

作　　者：米萌[1] 黄东宁 杨凯星 张金明[3] 黄强[1] 蒋协远[1] Mi Meng;Huang Dongning;Yang Kaixing;Zhang Jinming;Huang Qiang;Jiang Xieyuan(Department of Orthopaedic Trauma,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Orthopaedics,Bijie Chinese Medicine Hospital,Bijie 551700,Guizhou Province,China;Department of Orthopaedics,Beijing Mentougou District Hospital,Beijing 102300,China)

机构地区：[1]北京积水潭医院创伤骨科,100035 [2]贵州省毕节市中医院骨科,551700 [3]北京市门头沟区医院骨科,102300

出　　处：《中华创伤骨科杂志》2021年第11期991-994,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨经改良Judet入路手术治疗肩胛盂骨折的临床疗效。方法回顾性分析2014年1月至2020年1月北京积水潭医院创伤骨科采用改良Judet入路治疗并完整随访的25例肩胛盂骨折患者资料。男19例,女6例;平均年龄46岁(29~66岁);肩胛盂骨折根据Goss-Ideberg分型:Ⅱ型8例,Ⅳ型2例,Ⅴ型10例,Ⅵ型5例。应用Mimics 16.0软件进行CT三维重建,确定骨折诊断及分型,测量并记录肩胛骨关节面塌陷程度和移位程度。术后6个月采用Constant-Murley绝对值评分评估功能。结果术前肩胛骨关节面塌陷的平均高度为5.8 mm(1.2~6.3 mm),关节内骨折折端移位的平均距离为7.7 mm(2.1~12.9 mm)。骨折均在术后6个月内获骨性愈合。术后随访时间平均58.8个月(7~92个月)。术后6个月前屈上举角度平均158.6°(125°~180°),体侧外旋角度平均为39.0°(30°~45°)。术后6个月Constant-Murley绝对值评分平均为92.6分(75~100分),其中优19例,良5例,一般1例,优良率96%(24/25)。结论对于Goss-IdebergⅡ、Ⅳ、Ⅴ、Ⅵ型肩胛盂骨折,通过改良的Judet入路进行手术治疗,骨折可获确切的复位固定,临床疗效满意。Objective To analyze the treatment of scapular glenoid fractures via the modified Judet approach.Methods A retrospective study was conducted of the 25 patients who had been treated for scapular glenoid fractures via the modified Judet approach and completely followed up at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from January 2014 to January 2020.They were 19 males and 6 females with an average age of 46 years(from 29 to 66 years).According to the Goss-Ideberg classification,8 cases were diagnosed as typeⅡ,2 cases as typeⅣ,10 cases as typeⅤand 5 cases as typeⅥ.3D reconstruction of the CT scans by software Mimics 16.0 was made to confirm the diagnoses and classifications of the fractures.Articular step-off and displacement of the scapular glenoid were calculated and recorded.The functional outcomes were evaluated by Constant-Murley scoring system at 6 months postoperatively.Results Preoperatively,the mean articular step-off was 5.8 mm(from 1.2 to 6.3 mm)and the mean displacement 7.7 mm(from 2.1 to 12.9 mm).All fractures obtained bony union within postoperative 6 months.The mean follow-up period was 58.8 months(from 7 to 92 months).The forward flexion was 158.6°(from 125°to 180°)and the external rotation 39.0°(from 30°to 45°)at 6 months postoperatively.The mean Constant-Murley score was 92.6(from 75 to 100)at 6 months post-operatively;19 cases were excellent(76%),5 were good(20%)and one was fair(4%),giving an excellent to good rate of 96%(24/25).Conclusion For scapular glenoid fractures of Goss-Ideberg typesⅡ/Ⅳ/Ⅴ/Ⅵ,surgery via the modified Judet approach may promise satisfactory reduction and fixation and fine clinical outcomes.

关 键 词：关节内骨折 骨折固定术 内 成像 三维 肩胛盂骨折 

分 类 号：R687.3[医药卫生—骨科学]