前后联合入路治疗MillerⅢ型肩胛骨骨折

Operative treatment of Miller type Ⅲ scapular fractures through anterior and posterior approach

目的探讨前后联合入路治疗MillerⅢ型肩胛骨骨折的临床疗效。方法采用改良Judet入路和前入路切开复位、重建钢板塑形后固定治疗15例MillerⅢ型肩胛骨骨折患者。结果术中出血量500-580（545.61±10.94）ml,手术时间90-160（127.40±9.60）min。患者均获得随访,时间9-17个月。骨折均一期愈合,时间8-12（9.54±1.73）周,未出现骨不连、周围神经血管损伤等并发症。术后肩关节功能Constant评分：健侧98.13分±1.46分,患侧87.67分±3.52分,差异有统计学意义（P〈0.05）。肩关节上举：健侧152.47°±3.66°,患侧147.00°±10.82°,差异无统计学意义（P〉0.05）。肩关节外展：健侧151.07°±4.42°,患侧146.00°±10.79°,差异无统计学意义（P〉0.05）。盂极角：患侧均〉20°,平均为32.73°±1.94°,健侧平均为33.80°±1.97°,差异无统计学意义（P〉0.05）。结论前后联合入路治疗MillerⅢ型肩胛骨骨折功能恢复良好,盂极角、上举角度、外展角度均能达到理想要求,能满足患者的生活需要。

Objective To investigate the effect of operative treatment of Miller type Ⅲ scapular fractures through anterior and posterior approach. Methods Fifteen patients with the Miller type Ⅲ scapular fractures were treated through improved Judet and anterior approach,open reduction and reconstruction plate after shaping was used for fixation. Results The intraoperative blood loss was 500 - 580（ 545. 61 ± 10. 94） ml,the operative time was 90 - 160（ 127. 40 ± 9. 60） minutes. All patients were followed up for 9 - 17 months. Primary healing of fractures was obtained,bony healing time was 8 - 12（ 9. 54 ± 1. 73） weeks. No complications such as nonunion or peripheral nerve injury occurred. Functional evaluation was made according to the scoring system put forward by Constant： uninjured side： 98. 13 ± 1. 46 points,injured side： 87. 67 ± 3. 52 points,the differences were statistically significant（ P〉0. 05）. Elevation of shoulder joint lifting function： uninjured side 152. 47° ± 3. 66°,injured side： 147. 00° ± 10. 82°,there were no statistically significant differences（ P〉0. 05）. Abduction： uninjured side 151. 07° ± 4. 42° and injured side 146. 00° ± 10. 79°,there were no statistically significant differences（ P〉0. 05）. Glenopolar angle： all cases of affected side 20°,injured side： 32. 73° ± 1. 94°,uninjured side： 33. 80° ± 1. 97°,there were no statistically significant differences（ P〉0. 05）. Conclusions Anterior and posterior approach for internal fixation has good effectiveness in treating unstable Miller type Ⅲ scapular fractures,the glenopolar angle,elevation and abduction can meet good requirement. This method can satisfy their needs in life.