摘要
目的:报告肩胛颈、体部骨折严重重叠移位经肩胛骨外侧缘入路治疗方法和治疗效果,并与Judet入路治疗组进行比较。方法:回顾2002～2007年肩胛颈、体部骨折严重重叠移位的患者32例,其中经肩胛骨外侧缘入路治疗14例,Judet入路治疗18例。对两治疗组的手术时间、切口长度、出血量和功能恢复情况进行对比研究。结果:两组病例均得到随访,两组随访时间无明显差异。经肩胛骨外侧缘入路组平均手术时间、切口长度、出血量均显著优于对照组(P＜0.05)。参照Hardegger评定标准评价关节功能,经肩胛骨外侧缘入路治疗组优良率92.9%,Judet入路治疗组优优良率61.1%。经Ridit分析,两组对比有显著差异(P＜0.05)。结论:经肩胛骨外侧缘入路施术不需要从肩胛冈上大量剥离肌肉,出血少,显露简便,显露术野满意,容易复位和固定骨折,肩关节功能恢复好。
Objective: to describe the surgical treatment of scapular neck and body displaced or overlapped fractures through the approach of straight incision along lateral border of the scapula (SIALBS), and to evaluate and compare the clinical outcomes of this approach with that of the Judet approach. Methods: retrospective studies were performed on 32 cases of scapular neck and body displaced or seriously overlapped fractures admitted in the hospital from 2002 to 2007. Among them, 14 cases were operatively treated through the SIALBS approach and 18 cases through Judet approach. In the SIALBS group, there were 10 males and 4 females aged 21-61 years (averaged 33±2.3); 10 cases were type IV fracture and 4 were type II fracture; four patients were injured from falling, nine from accidents, and two from weights; the injury time before surgery was 2-14 days (averaged 3±1.2 day). In the Judet group, there were 13 males and 5 females aged 19-57 years (averaged 34±2. 5); 13 cases were type IV fracture and 5 were type II fracture; Seven patients were injured from falling, seven from accidents, and four from weights; the injury time before surgery was 2-15 days (averaged 4±2. 1 day). A comparative study was performed on the operating time, incision length, amount of bleeding, and functional recovery between the SIALBS and Judet treatment groups. Results: All patients were followed up and there was no difference in the follow-up period between the two groups. Statistical analysis found that the SIALBS approach markedly decreased the operation time, the incision length, and the amount of bleeding compared with Judet approach (P <0. 05, t-test). According to Hardegger's rating system, in the SIALBS group, 8 cases showed excellent, 4 showed good, 2 showed fair, and none showed poor; in the Judet group, the cases showed excellent, good, fair, and poor were 10, 4, 3, and 1, respectively. Compared to Judet approach, the SIALBS approach significantly increased the rate of excellent or good results (92.9% in SIALBS group vs61.1% in Judet group, P<0.05 with Ridit analysis). Conclusion: compared to the Judet approach, the SIALBS approach is less muscular dissection and causes less bleeding. Also, in the SIALBS operation, the exposure of operative field is adequate and simple, the fracture is easier to be reset and fixed, and the shoulder function recovers well.
引文
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