移位的肩胛盂骨折的手术治疗

Surgical treatment of displaced intra articular fractures of the glenoid fossa

目的 研究切开复位内固定治疗肩胛盂骨折的效果。方法 将 13例肩胛盂骨折患者按改良的Ideberg分型分类 ,Ⅰ型 2例 ,Ⅱ型 1例 ,Ⅲ型 1例 ,Ⅳ型 9例。Ⅰ、Ⅱ型用标准的三角肌胸大肌入路 ,骨折复位后用 2 7mm拉力螺钉固定。Ⅲ、Ⅳ型用后侧Judet入路 ,骨折复位后用AO重建钢板和螺钉固定。结果 术后随访 6～ 2 4个月 ,平均 14个月。以最后 1次检查结果为准 ,对肩关节的功能进行临床效果评定 :优 7例 ,前屈、外展、上举及内外旋转均较健侧差 10°～ 15°。良 4例 ,外展上举及内外旋转均较健侧差16°～ 3 0° ,前屈后伸正常。可 2例 ,肩关节各方活动、旋转均较健侧差 3 1°～ 60°。结论 开放复位内固定是治疗有移位的肩胛盂骨折的一种较好的方法。

ObjectiveTo investigate the results of open reduction and internal fixation for treatment of displaced intra articular fractures of the glenoid fossa.MethodsThirteen patients with displaced fractures of the glenoid fossa were categorized into four types according to modified Ideberg classification. There were 2 cases of typeⅠ fracture, 1 case of typeⅡ, 1 case of type Ⅲ and 9 cases of type IV. TypeⅠand typeⅡ fractures were fixed with lag screw through anterior pectoro deltoid approach . Type Ⅲ and type Ⅳ fractures were fixed with AO reconstructive plate and screws via posterior Judet approach. The follow up period ranged from 6 to 24 months (mean 14 months).ResultsTreatment outcome was evaluated at last visit. In 7 patients anterior flexion, abduction, elevation and rotation of the shoulder was limited by 10°～15° as compared to the normal side. Their recovery was graded as excellent. Four cases that were graded as good had limitation of abduction, elevation and rotation of the shoulder by 16°～30° as compared to the normal side. Two cases had fair results. Shoulder movement was limited by 31°～60° comparing to the normal side.ConclusionOpen reduction and internal fixation is an effective treatment for displaced intra articular fractures of the glenoid fossa.