肩胛骨骨折的手术治疗

Operative Treatment of Scapular Fractures

目的探讨肩胛骨骨折的手术适应证与手术复位内固定的临床效果。方法自1998年2月至2003年6月，对一组26例经手术复位内固定治疗的肩胛骨骨折患者进行回顾性分析，骨折按Hardegger分型，肩胛体部骨折14处，肩胛颈部骨折12处，其中解剖颈骨折1处，外科颈骨折11处，肩胛冈骨折5处，肩峰骨折4处，肩胛盂窝骨折5处。手术入路采用肩胛骨外侧缘入路17例，肩关节后方入路9例。术后早期行功能锻炼。结果本组26例均获随访，随访时间为12～56个月，平均30．5个月。X线片显示，所有患者均在8～12周达到骨性愈合，平均9周。根据Hardeg—ger功能评定标准评定，优16例，良7例，可2例，差1例，优良率为88．5％。术后创伤性关节炎2例，异位骨化1例，无伤口感染和骨不连。结论手术治疗肩胛骨骨折恢复了肩关节的动力平衡和稳定性，是一种安全可靠的治疗方法．合理的运用手术入路和内固定方式，早期行功能锻炼，可取得满意的临床疗效。

Objective To explore the operative indication and the clinical effect of scapular fractures were treated by open reduction and internal fixation. Methods From February 1998 to June 2003,26 patients of scapular fractures were treated by open reduction and internal fixation. All patients were reviewed retrospectively. According to Hardegger＇s classification for scapular fractures,there were 14 fractures of the scapular body, 12 fractures of the scapular neck,5 fractures of the scapular spine,4 fractures of the acromion and 5 fractures of the glenoid fossa, 17 cases were treatd through the lateral approach and 9 cases through posterior approach. The patients were requested to do earlier rehabilitation after operation. Results 26 patients were followed up for 12-56 months,average 30, 5 months. The evaluation of the results by Hardegger＇s functional rating scale revealed excellent in 16 eases,good in 7 cases,fair in 2 cases and poor in 1 case,excellent and good rate of clinical results were 88. 5%. The glenohumeral posttraumatic arthritis was found in 2 cases,heterotopic ossification in 1 case ,ther were no infection and all fractures healed in average 9 weeks after operation. Conclusion Scapular fractures were treated by open reduction and internal fixation is a good and safe method ,it can keep the stability and the balance of shoulder joint. It could make satisfactory clinical results through choose suitable surgical approach ,internal fixation methods and early exercises.