镍钛合金记忆弓齿钉在粉碎性肩胛骨骨折治疗中的应用

Shape memory alloy bow-teeth screws for treatment of comminuted scapula fractures

目的探讨镍钛合金记忆弓齿钉的特点及其辅助锁定钢板、空心螺钉内固定治疗粉碎性肩胛骨骨折的临床疗效。方法2002年3月至2010年6月采用记忆合金弓齿钉辅助锁定钢板、窄心螺钉内固定治疗12例粉碎性肩胛骨骨折患者，男8例，女4例；年龄18～55岁，平均35．2岁。骨折按照Hardegger分型：肩胛骨体部骨折5例．肩胛颈骨折2例，混合型骨折5例；均为伤后3周内手术的新鲜骨折。手术人路采用改良Judet入路或肩胛骨外侧缘人路。术后根据日本骨科协会（JOA）肩关节功能评分标准评定肩关节功能恢复情况。结果12例患者术后获14～30个月（平均17个月）随访。切口无感染，均一期愈合。术后3～12周患侧肩关节活动度达到或接近健侧水平；骨折骨性愈合时间为61～91d，平均66．0d。无骨折再移位、不愈合、内固定松动或断裂、血管神经损伤等并发症发生。肩关节功能恢复情况根据JOA肩关节功能评分标准评定：优8例，良3例，可1例，优良率为91．7％。结论镍钛合金记忆弓齿钉的合理设计更适合肩胛骨不规则的解剖结构，持续应力加压作用可促进骨质愈合，多点锁定可避免局部软组织大范围剥离；其结合锁定钢板、空心螺钉形成三维空间同定能有效恢复肩胛骨的解剖结构，是治疗粉碎性肩胛骨骨折的有效方法。

Objective To assess the medium-term results of shape memory alloy bow-teeth screws for internal fixation of comminuted scapula fractures. Methods From March 2002 to June 2010 in our department, 12 consecutive patients with unilateral severe scapula fracture were treated with internal fixation with shape memory alloy bow-teeth screws in combination of a locking plate and cannulated screws. They were 8 males and 4 females with a mean age of 35.2 years old （range, from 18 to 55 years） . All fractures were fresh, including 5 ones of scapula body, 2 ones of scapula neck and 5 mixed fractures of scapula according to the Hardegger classification. The modified Judet approach or approach to the lateral margin of the scapula was adopted. The functional recovery of the shoulder was evaluated according to Japanese Orthopaedic Association （JOA） system. Results The average follow-up time was 17 months （range, from 14 to 30 months）. All incisions healed primarily without any infection. The function of the injured shoulder was restored to the normal level or near the normal level from 3 to 12 weeks after operation. Bony union of the fracture was achieved after 61 to 91 days （average. 66.0 clays）. None of the patients lost reduction or suffered implant failure or neural or vaseular injury after surgery. By the JOA scores, 8 cases were rated as excellent, 3 as good and one as fair, with an excellent to good rate of 91.7%. Conclusions AS Ni-Ti shape memory alloy bow-teeth screws suit the irregular anatomy of the scapula, their continuing stress compression may facilitate fracture healing, and their muhi-locking may prevent massive dissection of the soft tissue. In combination with a locking plate and cannulated screws, they can provide a three-dimensional fixation to effectively recover the anatomic structure of the scapula. Consequently they are very effective for comminuted scapula fractures.