改良Judet入路手术治疗肩胛骨骨折

Modified Judet approach for surgical treatment of scapular fractures

目的介绍肩胛骨骨折手术的改良Judet入路，分析手术治疗肩胛骨骨折的临床疗效。方法2001年1月至2007年5月26例肩胛骨骨折患者接受改良Judet入路切开复位内固定手术，对经典的Judet入路进行改良，用经典Judet入路的皮肤切口，用Hardegger入路通过分离冈下肌与小圆肌间隙的方法来显露深层结构，并应用改良入路对26例肩胛骨骨折采用改良入路施行切开复位内固定术。结果术后22例患者获得随访6～28个月，平均18．9个月。骨折均在8～12周愈合，平均9．6周。疗效根据Hardegger等功能评定标准：优13例，良5例，可4例，优良率为81，3％。结论与经典Judet入路相比，改良入路不仅有经典入路的各种优点，而且最大限度的保留了肩袖肌肉的完整性，手术创伤明显减少。

Objective To introduce a modified Judet approach for scapular fracture and analyse the clinical findings and results of patient treated surgically for scapular fracture. Methods From January 2001 to May 2007, twenty - six cases with scapular fractures were treated by a modified Judet approach, open reduction and internal fixation. The classic Judet approach was modified using the skin incision of classic Judet approach, and the method of exposing the deep structure by splitting the infraspinatus and teres minor interval in Hardegger approach. The open reduction and internal fixation were performed on 26 patients with scapular fractures using modified approach. Results Twenty -two patients were followed up for 6 months to 28 months,18.9 months on average. All the fractures with open reduction healed after 8 to12 weeks,9.6 weeks on average. According to Hardegger function evaluation criterion,the excellent result was achieved in 13 patients, good in 5, fair in 4. Function recovery rate was 81.3%. Conclusions Compared with the classic Judet approach,the modified approach not only has all the advantages of classic approach, but also reserves the integrity of rotation cuff to its limit with the operation trauma decreased obviously.