腋窝入路肩胛盂前缘骨折复位固定的应用解剖学及临床研究  

An axillary approach for open reduction and internal fixation to treat anterior glenoid fracture:an anatomical and clinical study

作　　者：邢永 张子言[2] 郭琰[1] 侯国进[1] 丁坚[3] 吴丹凯[2] 田耘[1] Xing Yong;Zhang Ziyan;Guo Yan;Hou Guojin;Ding Jian;Wu Dankai;Tian Yun(Department of Orthopaedics,Engineering Research Center of Bone and Joint Precision Medicine,Peking University Third Hospital,Beijing 100191,China;Department of Orthopaedics,the Second Hospital of Jilin University,Changchun 130041,China;Department of Orthopaedics,Shanghai Sixth People's Hospital,Shanghai 200233,China)

机构地区：[1]北京大学第三医院骨科,骨与关节精准医学教育部工程研究中心,100191 [2]吉林大学第二医院骨科,长春130041 [3]上海市第六人民医院骨科,200233

出　　处：《中华骨科杂志》2022年第1期18-25,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨腋窝入路肩胛盂前缘骨折复位固定的可行性及临床疗效。方法取两具新鲜成人大体标本(4侧肩关节),模拟经腋窝入路行肩胛盂前缘骨折切开复位内固定手术。标本置于侧卧位,于腋后线切开,经背阔肌前侧肌肉间隙显露肩胛骨侧方,分离并保护腋神经、旋肱后动脉、胸背神经及旋肩胛动脉等周围重要组织。腋窝入路下术野分为上侧"四边区"及下侧"三边区",可显露肩胛盂前下侧、肩胛颈及肩胛骨外侧缘全长。2018年4月至2020年12月采用腋窝入路肩胛盂切开复位内固定术治疗肩胛盂前缘骨折13例,男7例、女6例;年龄(50.38±13.74)岁(范围24~67岁);右肩12例、左肩1例,均为IdebergⅠa型骨折。采用解剖型支撑钢板固定5例、空心螺钉联合掌骨钢板固定7例、桡骨远端钢板固定1例。术后采用Constant-Murley评分、上肢功能评分(disabilities of the arm,shoulder and hand,DASH)评价临床疗效。结果全部病例均获得随访,随访时间(13.00±5.97)个月(范围6~26个月)。骨折均在6个月内愈合,无延迟愈合及畸形愈合。术后3个月Constant-Murley评分为(62.46±10.26)分(范围45~83分),DASH评分为(27.56±9.76)分(范围14.14~43.33分);术后6个月Constant-Murley评分为(80.85±8.32)分(范围65~90分),DASH评分为(11.47±8.56)分(范围0~35.00分);终末随访时Constant-Murley评分为(84.54±8.95)分(范围70~95分),DASH评分为(10.94±8.67)分(范围1.67~33.33分);随时间延长,关节功能逐渐恢复,术后3个月与术后6个月及末次随访时Constant-Murley评分和DASH评分的差异均有统计学意义(P<0.05)。结论腋窝入路是治疗肩胛骨前缘骨折安全、可行的入路;可显露肩胛盂前下侧和肩胛骨外侧缘,减少肩袖损伤,实现骨折解剖复位及坚强固定,并允许术后早期功能锻炼。Objective To investigate the clinical effect and safety of reduction and fixation for the anterior glenoid fracture through an axillary approach.Methods Two autopsy specimens(a total of 4 shoulder joints)were used to simulate the surgery of open reduction and internal fixation to treat anterior glenoid fracture through an axillary approach.Specimens were placed in the lateral decubitus position.An incision was made in the posterior axillary line to expose the lateral side of the scapula through the interval ahead of the latissimus dorsi muscle.Attended to the separation and protection of the axillary nerve,posterior humerus artery,thoracic dorsal nerve,and scapular artery.The surgical area of the axillary approach was divided into the upper"quadrilateral area"and the lower"trilateral area",which exposed the anteroinferior glenoid,neck,and the full length of lateral border of the scapula.Thirteen cases(7 males and 6 females)were involved in this study,all patients were diagnosed with anterior glenoid fracture and treated by open reduction and internal fixation through the axillary approach between April 2018 and December 2020.Constant-Murley score and Disabilities of the Arm,Shoulder and Hand(DASH)were used to evaluate the clinical efficacy.Results Thirteen patients were enrolled for final analysis,which included 12 right cases and 1 left case.The average age was 50.38±13.74 years(range 24-67 years).All 13 patients were classified as Ideberg type Ia fracture.Anatomical buttress plates were used in 5 cases,cannulated screws combined with metacarpal plates in 7 cases,and distal radius plate in 1 case.The average length of follow-up was 13.00±5.97 months(range 6-26 months).No delayed union or malunion in all cases at the last follow-up visits.The average of Constant-Murley score was 62.46±10.26 points(range 45-83)and the DASH score was 27.56±9.76 points(range 14.14-43.33)at the three months follow up visits.At 6 months postoperatively,the Constant-Murley score was 80.85±8.32 points(range 65 to 90)and the DASH sc

关 键 词：骨折切开复位 骨折固定术 内 肩胛骨 关节盂 BANKART损伤 

分 类 号：R687.3[医药卫生—骨科学]