腋窝后缘入路治疗部分肩胛骨骨折的初步疗效分析  

Posterior axillary approach for treatment of some scapular fractures

作　　者：张子言[1] 邢永 丁坚[3] 陈华[4] 郭琰[2] 何百川 彭传刚[1] 任广凯 吴丹凯[1] 田耘[2] Zhang Ziyan;Xing Yong;Ding Jian;Chen Hua;Guo Yan;He Baichuan;Peng Chuangang;Ren Guangkai;Wu Dankai;Tian Yun(Department of Traumatology,The Second Hospital of Jilin University,Changchun 130041,China;Department of Traumatology,The Third Hospital of Peking University,Beijing 100191,China;Department of Traumatology,The Sixth People's Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200233,China;Department of Traumatology,General Hospital of the Chinese People's Liberation Army,Beijing 100853,China)

机构地区：[1]吉林大学第二医院创伤骨科,长春130041 [2]北京大学第三医院创伤骨科,北京100191 [3]上海交通大学附属第六人民医院创伤骨科,上海200233 [4]解放军总医院创伤骨科,北京100853

出　　处：《中华创伤骨科杂志》2022年第5期414-420,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨采用腋窝后缘入路(腋后路)治疗部分肩胛骨骨折的疗效。方法回顾性分析2018年4月至2021年7月吉林大学第二医院创伤骨科接受腋后路治疗的41例肩胛骨骨折患者资料。男32例, 女9例;年龄为24~83岁, 平均52.4岁。7例患者存在多发伤, 16例患者合并其他部位骨折;4例患者存在臂丛神经损伤。记录患者的手术切口长度、术中出血量、手术时间及末次随访时肩关节活动度、上肢功能障碍(DASH)评分、Constant肩关节评分及术后并发症发生情况。结果手术切口长度7~12 cm, 平均9.3 cm;术中出血量为80~150 mL, 平均110.5 mL;腋后路的显露时间为5~10 min, 平均7.9 min;骨折手术时间85~140 min, 平均110.8 min。41例患者术后获6~36个月(平均14.3个月)随访。末次随访时肩关节活动度:前屈平均177°(150°~180°), 外展平均175°(140°~180°), 后伸平均47°(30°~50°)。末次随访时DASH评分平均为36.4分(34~46分), Constant评分平均为96.0分(84~100分)。随访期间无骨折复位丢失、钢板及螺钉松动或断裂等并发症发生。2例患者出现切口延迟愈合, 2例患者出现轻微的异位骨化。结论腋后路是一种治疗肩胛骨骨折的新型手术入路, 可直视下进行肩胛盂、颈、体骨折的内固定, 术后切口美观, 疗效可靠。Objective To investigate the efficacy of the posterior axillary approach in the treatment of some scapular fractures.Methods Retrospectively analyzed were the data of 41 patients with scapular fracture who had been treated through the posterior axillary approach at Department of Traumatology,The Second Hospital of Jilin University from April 2018 to July 2021.There were 32 males and 9 females,aged from 24 to 83 years(average,52.4 years).Of them,7 were complicated with multiple injuries,16 with other fractures,and 4 with brachial plexus injury.Recorded were length of surgical incision,intraoperative blood loss,operation time,and range of shoulder motion,Disability of Arm Shoulder and Hand(DASH)score,Constant shoulder score and postoperative complications at the last follow-up.Results In this cohort,length of incision ranged from 7 to 12 cm(average,9.3 cm),intraoperative blood loss from 80 to 150 mL(average,110.5 mL),exposure time of the posterior axillary approach from 5 to 10 min(average,7.9 min),and fracture operation time from 85 to 140 min(average,110.8 min).The 41 patients were followed up for 6 to 36 months(mean,14.3 months)after surgery.At the last follow-up,the average ranges of shoulder motion were 177°(from 150°to 180°)in flexion,175°(from 140°to 180°)in abduction and 47°(from 30°to 50°)in extension,the average DASH score was 36.4 points(from 34 to 46 points),and the average Constant score 96.0 points(from 84 to 100 points).There were no complications like loss of fracture reduction,loosening or breakage of plate or screw during follow-up.Incision healing was delayed in 2 patients and mild heterotopic ossification occurred in 2 patients.Conclusion As a new surgical approach for some scapular fractures,the posterior axillary approach allows internal fixation of the fractures of the scapular glenoid,neck and body under direct vision,leading to good-looking postoperative wound and reliable curative effects.

关 键 词：肩关节 肩胛骨 骨折固定术 腋窝后缘入路 骨性Bankart损伤 

分 类 号：R687.3[医药卫生—骨科学]