| 经腋窝后缘入路与肩胛骨外侧缘入路治疗肩胛骨骨折的对照研究 |
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Received:December 04, 2024
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| 作者 | Author | 单位 | Unit | E-Mail |
| 李冰 |
LI Bing |
南京中医药大学附属武进中医医院骨伤科, 江苏 常州 213161 |
Department of Orthopaedics, Wujin Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Changzhou 213161, Jiangsu, China |
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| 徐鹏 |
XU Peng |
南京中医药大学附属武进中医医院骨伤科, 江苏 常州 213161 |
Department of Orthopaedics, Wujin Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Changzhou 213161, Jiangsu, China |
lisirvip@163.com |
| 袁亚兵 |
YUAN Ya-bing |
南京中医药大学附属武进中医医院骨伤科, 江苏 常州 213161 |
Department of Orthopaedics, Wujin Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Changzhou 213161, Jiangsu, China |
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| 张兴州 |
ZHANG Xing-zhou |
南京中医药大学附属武进中医医院骨伤科, 江苏 常州 213161 |
Department of Orthopaedics, Wujin Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Changzhou 213161, Jiangsu, China |
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| 何樟宁 |
HE Zhang-ning |
南京中医药大学附属武进中医医院骨伤科, 江苏 常州 213161 |
Department of Orthopaedics, Wujin Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Changzhou 213161, Jiangsu, China |
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| 期刊信息：《中国骨伤》2025年38卷，第3期，第231-237页 |
| DOI：10.12200/j.issn.1003-0034.20240719 |
| 基金项目:江苏省常州市卫健委科技项目(编号:WZ202310) |
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目的: 比较经腋窝后缘入路与经肩胛骨外侧缘入路治疗MillerⅡ、Ⅳ型肩胛骨骨折的临床疗效。
方法: 回顾性分析自2020年6月至2024年6月采用切开复位锁定钢板内固定治疗的28例新鲜肩胛骨骨折(MillerⅡ、Ⅳ型)患者,按手术入路方式不同分为两组。腋窝后缘组13例,男8例,女5例;年龄26~71(39.2±6.5)岁;Miller分型,Ⅱ型5例,Ⅳ型8例;摔伤9例,车祸伤4例;右侧7例,左侧6例;受伤至手术时间3~5(4.07±0.86) d。肩胛骨外侧缘组15例,男10例,女5例;年龄27~63(43.6±8.5)岁;Miller分型,Ⅱ型7例,Ⅳ型8例;摔伤10例,车祸伤5例;右侧6例,左侧9例;受伤至手术时间3~5(4.20±0.67) d。比较两组手术时间、术中失血量、骨折愈合时间、术后即刻盂极角(glenopolar angle,GPA)等情况。分别于术后3、6个月时采用疼痛视觉模拟评分(visual analogue scale,VAS)、Constant-Murley肩关节功能评分进行临床疗效评价,并于术后6个月评价关节活动度情况。
结果: 所有患者未出现伤口感染、血管和神经损伤、内固定松动或断裂。两组均获得随访,时间8~12(9.6±1.5)个月。腋窝后缘组手术时间、术中失血量分别为(76.92±5.60) min、(84.86±10.08) ml,优于肩胛骨外侧缘组(84.67±6.93) min、(115.00±12.39) ml,差异有统计学意义(P<0.05)。腋窝后缘组、肩胛骨外侧缘组术后即刻GPA[(36.62±0.87)°、(36.20±0.82)°]较术前[(16.10±1.14)°、(16.20±1.20)°]显著改善,差异有统计学意义(P<0.05),但两组间比较差异无统计学意义(P>0.05)。两组骨折愈合时间及术后3、6个月VAS比较,差异均无统计学意义(P>0.05)。术后3个月腋窝后缘组Constant-Murley评分(75.00±4.02)分高于肩胛骨外侧缘组(70.86±4.24)分,差异有统计学意义(P<0.05),术后6个月两组比较差异无统计学意义(P>0.05)。术后6个月,腋窝后缘组关节活动度前屈(160.38±13.61)°、外展(154.61±13.91)°、外旋(83.08±2.53)°、内旋(62.69±2.59)°、后伸(51.54±3.15)°,大于肩胛骨外侧缘组(148.00±15.44)°、(144.00±11.05)°、(79.67±3.99)°、(57.33±4.95)°、(47.33±4.16)°,差异有统计学意义(P<0.05)。
结论: 与肩胛骨外侧缘肌间隙入路相比,经腋窝后缘入路Buttress固定治疗MillerⅡ、Ⅳ型肩胛骨骨折,术中视野暴露广泛,骨折支撑固定稳固,手术创伤小,手术时间短,术中出血量少,为治疗复杂肩胛骨骨折提供新的借鉴。 |
| [关键词]:肩胛骨骨折 腋窝后缘入路 肩胛骨外侧缘入路 病例对照研究 |
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| Comparative study of the treatment of scapular fractures by posterior axillary and lateral scapular approaches |
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Abstract:
Objective To compare clinical efficacy of transaxillary posterior margin approach and translateral margin approach for the treatment of Miller typeⅡand Ⅳ scapular fractures.
Methods From June 2020 to June 2024,28 patients with fresh scapular fractures (Miller typeⅡand Ⅳ) who were treated with open reduction and locked plate internal fixation were retrospectively analyzed and divided into two groups. There were 13 patients in posterior axillary margin group,including 8 males and 5 females,aged from 26 to 71 years old with an average of (39.2±6.5) years old;5 patients with typeⅡand 8 patients with type Ⅳ according to Miller classification;9 patients caused by falling down,4 patients caused by car accident;7 patients on the right side,6 patients on the left side;the time from injury to operation ranged from 3 to 5 days with an average of (4.07±0.86) days. There were 15 patients in lateral scapula margin group,including 10 males and 5 females,aged from 27 to 63 years old with an average of (43.6±8.5) years old;7 patients with typeⅡand 8 patients with type Ⅳ according to Miller classification;10 patients caused by falling down,5 patients caused by car accident;6 patients on the right side,9 patients on the left side;the time from injury to operation ranged from 3 to 5 days with an average of (4.20±0.67) days. Operative time,intraoperative blood loss,fracture healing time,glenopolar angle (GPA) immediately after operation were compared between two groups. Visual analogue scale (VAS) and Constant-Murley shoulder joint function score were used to evaluate clinical effect at 3 and 6 months after operation,respectively,and the joint motions were evaluated at 6 months after operation.
Results None of patients occurred wound infection,vascular and nerve damage,loosening or rupture of internal fixation. Both groups were followed up for 8 to 12 months with an average of (9.6±1.5) months. Operative time and intraoperative blood loss of posterior axillary margin group were (76.92±5.60) min and (84.86±10.08) ml,respectively,which were better than those of lateral scapula margin group(84.67±6.93) min and(115.00±12.39) ml(P<0.05). Immediate GPA in posterior axillary margin group (36.62±0.87) ånd lateral scapula margin group (36.20±0.82)°were significantly improved compared with preoperative (16.10±1.14) °,(16.20±1.20) °(P<0.05),while there was no statistical significance between two groups (P>0.05). There were no significant difference in fracture healing time and postoperative VAS at 3 and 6 months between two groups (P>0.05). Postoperative Constant-Murley score of posterior axillary margin group (75.00±4.02) was higher than that of lateral scapular margin group (70.86±4.24) at 3 months (P<0.05),while there was no significant difference between two groups at 6 months after operation (P>0.05). At 6 months after operation,joint motion of posterior axillary margin group in flexion (160.38±13.61)°,abduction (154.61±13.91)°,rotation (83.08±2.53)°,rotation (62.69±2.59) ° and extension (51.54±3.15) °,respectively,which were higher than that of lateral scapular margin group in (148.00±15.44)°,(144.00±11.05)°,(79.67±3.99)°,(57.33±4.95)°,(47.33±4.16)°(P<0.05).
Conclusion Compared with lateral margin of scapula intermuscular space approach,Buttress approach through the posterior axillary margin for the treatment of Miller typeⅡand Ⅳ scapular fractures provides extensive intraoperative visual field exposure,stable fracture support and less surgical trauma,which could shorten operative time and reduce intraoperative blood loss,providing a new reference for the treatment of complex scapular fractures. |
| KEYWORDS:Fracture of shoulder blade Posterior axillary margin approach Lateral border approach scapula Case-control study |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李冰,徐鹏,袁亚兵,张兴州,何樟宁.经腋窝后缘入路与肩胛骨外侧缘入路治疗肩胛骨骨折的对照研究[J].中国骨伤,2025,38(3):231~237 |
| 英文格式: | LI Bing,XU Peng,YUAN Ya-bing,ZHANG Xing-zhou,HE Zhang-ning.Comparative study of the treatment of scapular fractures by posterior axillary and lateral scapular approaches[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(3):231~237 |
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