经肩袖肌间隙入路和Judet入路治疗肩胛骨骨折的比较研究

Comparative study of surgical treatments of scapula fracture through the muscle space of rotator cuff approach and Judet approach

目的探讨经肩袖肌间隙入路和Judet入路治疗肩胛骨骨折的疗效。方法2014年1月—2015年12月,采用切开复位、重建钢板内固定治疗50例肩胛骨骨折患者。其中24例采用经肩袖肌间隙入路(A组),26例采用Judet入路(B组)。两组患者性别、年龄、致伤原因、骨折分型、受伤至手术时间等一般资料比较,差异均无统计学意义(P>0.05)。记录两组手术时间、术中出血量及切口长度,X线片复查骨折愈合,根据Hardegger等评定标准评定疗效。结果A组手术时间、术中出血量及切口长度均明显小于B组(P<0.05)。两组术后切口均Ⅰ期愈合。两组患者均获随访,A组随访时间为6~13个月,平均11.6个月;B组为7~15个月,平均12.1个月。末次随访时,根据Hardegger等评定标准A组获优19例、良4例、可1例,优良率为95.8%;B组获优15例、良4例、可5例、差2例,优良率为73.1%;两组疗效比较差异有统计学意义(χ2=4.81,P=0.03)。X线片复查示,两组骨折复位及内固定满意,骨折均愈合,A组愈合时间为(29.86±8.38)周,B组为(30.05±7.99)周,差异无统计学意义(t=0.16,P=0.87)。结论与Judet入路相比,经肩袖肌间隙入路治疗肩胛骨骨折,视野显露清晰,肌肉剥离范围小,切口小,出血少,手术时间短,骨折复位内固定操作简便,可获得良好疗效。

Objective To study the surgical treatments of scapula fracture through the muscle space of rotator cuff approach and the Judet approach,and to evaluate and compare the clinical results.Methods Between January 2014 and December 2015,50 patients with scapula fractures were treated with open reduction and internal fixation of reconstruction plate.Twenty-four patients were treated through the muscle space of rotator cuff approach(group A),and 26 patients were treated through the Judet approach(group B).There was no significant difference in gender,age,cause of injury,type of fracture,and the interval between injury and operation(P>0.05).The operation time,intraoperative blood loss,and incision length were recorded,and the shoulder functions after fracture healing confirmed by X-ray films were evaluated according to the Hardegger’s scoring system.Results The operation time,intraoperative blood loss,and incision length in group A were significantly lower than those in group B(P<0.05).The incisions of the two groups healed by first intention.All patients were followed up 6-13 months(mean,11.6 months)in group A and 7-15 months(mean,12.1 months)in group B.According to Hardegger standard,the effectiveness was rated as excellent in 19 cases,good in 4 cases,and fair in 1 case,with the excellent and good rate of 95.8%in group A,and as excellent in 15 cases,good in 4 cases,fair in 5 cases,and poor in 2 cases with the excellent and good rate of 73.1%in group B.The difference in effectiveness between 2 groups was significant(χ2=4.81,P=0.03).X-ray films showed that the reduction and internal fixation were satisfied and the fractures healed in 2 groups.The fracture healing time were(29.86±8.38)weeks in group A and(30.05±7.99)weeks in group B,showing no significant difference between 2 groups(t=0.16,P=0.87).Conclusion Compared with the Judet approach,the muscle space of rotator cuff approach has advantages of clearly exposure,less muscular dissection,less intraoperative blood loss,less operation time,easier operation,and satisfied shoulder function can be obtained.