经腋窝入路直捷通道下加压螺钉结合支撑钢板治疗IdebergⅡ型肩胛盂骨折  

Treatment of Ideberg typeⅡscapular glenoid fracture with compression screw combined with Buttress plate through direct axillary approach

作　　者：张剑平 刘晖 徐维臻 熊远飞 张金辉 吴进 ZHANG Jianping;LIU Hui;XU Weizhen;XIONG Yuanfei;ZHANG Jinhui;WU Jin(Department of Orthopaedics,Joint Support Force 909th Hospital of Chinese PLA,Southeast Hospital of Xiamen University,Zhangzhou Fujian,363000,P.R.China)

机构地区：[1]中国人民解放军联勤保障部队第九〇九医院暨厦门大学附属东南医院骨科,福建漳州363000

出　　处：《中国修复重建外科杂志》2023年第11期1375-1379,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：全军后勤科研项目(20XLS21)。

摘　　要：目的探讨经腋窝入路直捷通道下加压螺钉结合支撑钢板内固定治疗IdebergⅡ型肩胛盂骨折的疗效。方法回顾分析2014年1月—2022年6月采用经腋窝入路直捷通道下加压螺钉结合支撑钢板内固定治疗的11例IdebergⅡ型肩胛盂骨折患者临床资料。其中男7例,女4例;年龄34~75岁,平均56.0岁。致伤原因:高处坠落伤4例,重物砸伤4例,交通事故伤3例。受伤至手术时间2~5 d,平均3.8 d。记录手术时间、术中出血量、住院时间、并发症发生及骨折愈合情况;采用Constant-Murley评分、美国肩肘外科医师协会(ASES)评分和肩关节前屈、外展、外旋(中立位)、内旋(中立位)活动度评估肩关节疼痛及功能情况。结果手术时间45~105 min,平均79.0 min;术中出血量80~200 mL,平均99.2 mL;住院时间3~8 d,平均5.8 d。1例患者术后出现切口愈合不良,经加强换药后愈合;其余患者切口均Ⅰ期愈合,无腋神经麻痹者。除1例失访外,余10例患者获随访10~54个月,平均26.4个月。术后X线片示骨折均愈合,愈合时间8~15周,平均11.0周。随访期间未发生骨折再移位和内固定物失效、断裂等并发症。末次随访时患者肩关节前屈、外展、外旋(中立位)、内旋(中立位)活动度及Constant-Murley评分、ASES评分均较术前显著改善,差异有统计学意义(P<0.05)。结论经腋窝入路直捷通道下加压螺钉结合支撑钢板内固定是治疗IdebergⅡ型肩胛盂骨折的有效方式,具有创伤小、切口隐蔽、临床疗效良好等优点。Objective To investigate the effectiveness of compression screw combined with Buttress plate through direct axillary approach for Ideberg typeⅡscapular glenoid fractures.Methods A retrospective analysis was conducted on 11 patients with Ideberg typeⅡscapular glenoid fractures treated with compression screws combined with Buttress plate fixation through the direct axillary approach between January 2014 and June 2022.There were 7 males and 4 females,aged from 34 to 75 years,with an average of 56.0 years.The causes of injury included 4 cases of falling from height injury,4 cases of heavy object injury,and 3 cases of traffic accident injury.The time from injury to operation was 2-5 days,with an average of 3.8 days.The operation time,intraoperative blood loss,hospital stay,complications,and fracture healing time were recorded.The Constant-Murley score,American Society of Shoulder and Elbow Surgeons(ASES)score,and shoulder joint flexion,abduction,external rotation(neutral position),and internal rotation(neutral position)range of motion were used to evaluate shoulder joint pain and function.Results The operation time was 45-105 minutes,with an average of 79.0 minutes;the intraoperative blood loss was 80-200 mL,with an average of 99.2 mL;the hospital stay was 3-8 days,with an average of 5.8 days.One patient had poor wound healing after operation,and the wound healed after strengthening dressing change;the rest wounds had primary healing,and no axillary nerve paralysis occurred.Except for 1 patient lost follow-up,the remaining 10 patients were followed up 10-54 months,with an average of 26.4 months.The postoperative X-ray film examination showed that the fractures healed well within 8-15 weeks,with an average of 11.0 weeks.There was no complication such as fracture displacement,internal fixator failure or fracture during follow-up.At last follow-up,the patient’s shoulder joint flexion,abduction,external rotation(neutral position),and internal rotation(neutral position)range of motion,Constant-Murley score,and ASES s

关 键 词：肩胛盂骨折 腋窝入路 Ideberg分型 加压螺钉 支撑钢板 内固定 

分 类 号：R687.3[医药卫生—骨科学]