后外侧肌间隙入路结合重建或锁骨锁定钢板治疗肩胛骨骨折的临床效果研究  

Clinical Effect of Posterolateral Minimally Invasive Muscle Space Approach Combined with Reconstruction or Clavicular Locking Plate in the Treatment of Scapular Fractures

作　　者：周孝斌 曾红生 陈子华[1] ZHOU Xiao-bin;ZENG Hong-sheng;CHEN Zi-hua(Department of orthopedics,Heyuan hospital affiliated to Jinan university,Heyuan,Guangdong province 517000)

机构地区：[1]暨南大学附属河源医院骨一科,广东河源517000

出　　处：《中国伤残医学》2023年第3期1-4,共4页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:探讨采用经肩后外侧缘肌间隙入路结合重建或锁骨锁定钢板治疗肩胛骨颈、体部骨折的临床疗效研究。方法:选取我院2015年1月-2019年12月采用肩后外侧微创肌间隙入路切开复位结合重建及锁骨锁定钢板固定治疗肩胛骨颈体部骨折14例。男13例,女1例,年龄27-55岁,平均年龄46岁。外伤原因:车祸伤7例,高空跌落伤4例,重物砸伤3例,14例均为不稳定型肩胛骨颈骨折,13例合并有同侧肋骨骨折及胸部损伤,其中3例为浮肩损伤。受伤至手术的间隔时间2-12天,平均5天。结果:平均手术用时60.8分钟,手术出血量约100.8 ml;术后均未发生切口感染;14例均获随访,随访时间为6-18个月,平均随访时间12个月。骨折均获临床愈合,愈合时间为24-48周,平均32周;患者肩关节功能恢复满意,无钢板螺钉松动断裂等并发症发生;随着术后持续的功能锻炼,患者肩关节活动功能逐渐改善,术后12个月左右返院拆除内固定时和末次随访时肩关节功能均明显优于术后6个月(P<0.05);术后12个月拆除内固定时的肩关节功能和末次随访比较差异无统计学意义(P>0.05)。结论:肩后外侧微创肌间隙入路结合重建及锁骨锁定钢板治疗肩胛骨骨折,可避免广泛显露剥离肩背部肌肉造成的血管及神经损伤风险,而重建及锁骨锁定钢板无需过度塑型,采用该入路结合锁定重建及锁骨钢板治疗肩胛骨骨折可取得较好的临床疗效。Objective:To investigate the clinical effect of the treatment of scapular neck and body fractures through the posterolateral marginal muscle space approach combined with reconstruction or clavicular locking plate.Methods:From January 2015 to December 2019,14 cases of scapular neck body fracture were treated by open reduction combined with reconstruction and clavicular locking plate fixation through posterolateral shoulder minimally invasive muscle space approach.There were 13 males and 1 female;The average age was 46 years(range,27-55 years).Causes of injury:7 cases of traffic accident injury,4 cases of high altitude fall injury,3 cases of heavy object injury,14 cases of unstable scapular neck fracture,13 cases of ipsilateral rib fracture and chest injury,3 cases of floating shoulder injury.The interval between injury and operation was 2-12 days,with an average of 5 days.Results:The average operation time was 60.8 min and the blood loss was about 100.8 ml.No incision infection occurred after operation.All the 14 cases were followed up for 6-18 months,with an average of 12 months.The healing time was 24-48 weeks(average 32 weeks).The shoulder function of the patients recovered satisfactorily,and no complications such as plate and screw loosening and breakage occurred.After operation,the constant shoulder score,DASH score and VAS score of each follow-up segment were improved continuously(P<0.05);With the continuous functional exercise after operation,the shoulder joint function of the patients gradually improved,and the shoulder joint function at 12 months after operation and at the last follow-up was significantly better than that at 6 months after operation(P<0.05);There was no significant difference in shoulder joint function at 12 months after operation and at the last follow-up(P>0.05).Conclusion:The posterolateral approach combined with reconstruction and clavicular locking plate in the treatment of scapular fractures can avoid the risk of vascular and nerve injury caused by extensive exposure of the back mus

关 键 词：肩胛骨骨折 微创入路 锁定钢板 重建钢板 

分 类 号：R683.41[医药卫生—骨科学]