肩胛骨外侧缘入路内固定治疗肩胛骨骨折26例疗效分析

目的对肩胛骨骨折患者应用肩胛骨外侧缘入路内固定治疗效果进行评估。方法纳入自2012年5月至2017年3月由于肩胛骨骨折手术患者26例，由肩胛骨外侧缘入路切口，行螺钉固定手术治疗。术后2~3周在医生指导下进行2周摆臂锻炼，辅以被动外展活动，术后4周在医生指导下进行主动功能锻炼。结果26例患者术后获7～20个月随访，骨折愈合时间为6~8周，所有患者均获得骨性愈合，无切口感染及深部感染，未发现神经损伤、神经卡压、钢板松动、螺钉松动及断裂等其他并发症，无肩关节畸形。术后均采用Hardegger等功能评定标准进行评分，优14例，良8例，可4例，患者肩关节功能恢复优良率84．6％。结论运用肩胛骨外侧缘手术入路治疗不稳定的肩胛骨折，配合积极的功能锻炼，患者创伤及出血少，肩关节功能恢复良好，临床治疗效果满意。

Objective To evaluate the clinical result of the effect of treatment on scapula fracture of the patients by the surgery of fixation through scapula lateral margin approach. Methods 26 cases of patients with scapula fractures who underwent the surgery were selected in the first hospital of Jiaxing city, Zhejiang province from May 2012 to March 2017. The lateral border of the scapular was selected as the way of surgery and did internal fixation for all cases. After 2-3 weeks of the surgery, patients began a two-weeks arm exercises combined with passive outreach under the guidance of doctors. After four weeks, patients did functional exercise under the guidance of doctors. Results 26 patients were followed up for 7-20 months. Fracture healing time was 6-8 weeks.All patients were healed with no wound infection and deep infection.No nerve damage, nerve entrapment, steel loose or other complications, such as screw loosening, fracture and shoulder deformity was found. Hardegger evaluation and other functions criteria were used.The excellent score was in 14 cases, while good in 8 cases and common in 4 cases, the excellent rate of recovery of shoulder function was 84.6%. Conclusion The use of scapula lateral margin approach surgical treatment of unstable shoulder fracture, with a positive exercise will make less trauma and bleeding, and get good recovery of shoulder function.The clinical results are satisfactory.