经反Judet入路治疗肩胛骨体部复杂骨折的疗效评价

Evaluation of reverse Judet approach in the treatment of scapular body complicated fractures

目的评价反Judet手术入路行肩胛骨体部复杂骨折手术治疗的临床疗效。方法回顾性分析2013年1月-2019年1月收治36例肩胛骨体部复杂骨折患者临床资料, 其中男29例, 女7例, 年龄20~63岁, 平均46岁。其中高能量交通伤20例, 高处坠落伤13例, 重物砸伤3例, Miller ME分型均为Ⅳ型。患者术前均行肩胛骨CT扫描及三维重建, 术中采用反Judet入路显露肩胛骨, 使用重建钢板行骨折内固定手术, 术后指导功能锻炼并随访临床疗效。同时对照分析同时间段20例肩胛骨体部复杂骨折采用经典Judet入路手术患者临床资料, 比较其手术时间及术中失血量、切口愈合情况及术后1年肩关节功能评分。结果 36例患者手术切口均Ⅰ期愈合, 无感染及肌皮瓣坏死, 患者均获门诊随访1~6年, 平均3.8年, 按Hardegger疗效评价标准, 优28例, 8例, 优良率为100%。手术时间及手术出血量对比经典Judet入路有统计学差异(P<0.001)。结论对于手术治疗肩胛骨体部复杂骨折, 可采用肌皮瓣分离的反Judet入路, 操作简单, 可缩短手术时间及减少术中出血, 术中骨折暴露充分, 有利于骨折复位及牢固固定, 术后可早期功能锻炼, 可做为手术治疗体部复杂骨折的安全有效的入路选择。

Objective:To evaluate the clinical effect of surgical treatment of scapular body complicated fractures with reverse Judet operation approach.Methods:A retrospective review was made on 36 patients with scapular body complicated fractures from Jan.2013 to Jan.2019.All the fractures were typeⅣaccording to Miller ME classification.There were 29 males and 7 females,at mean age of 46 years(ranged from 20 to 63 years).High energy traffic injury occurred in 13 patients,high fall injury in 8 patients,heavy pound in 3 patients.CT scan and 3D reconstruction were performed before operation,to expose the scapula with reverse Judet approach and do the internal fixation operation with reconstruction plate.Instructed the patients in functional exercises and clinic effects.All patients were followed up after operation.Twenty patients with scapular body complicated fractures from Jan.2013 to Jan.2019 treated by classic Judet approach operation were control analysised,compared the operation time,blood less,Incision healing and the shoulder function score after 1 year postoperation.Results:One-stage incision healing were achieved in all 36 patients,no infection and necrosis occurred in the muscle and skin flaps,all patients were followed up for 1 to 6 years(mean 3.8 years).According to Hardegger evaluation standard,28 cases were excellent,8 cases were good,the excellent and good rate was 100%.Opteration time and blood loss were less than those in classic Judet group,the differences were significant(P<0.001).Conclusion:For the surgical treatment of complicated fractures,reverse Judet approach that muscle flap and skin flap separated is feasible,the operation is simple,which can obviously shorten the operation time and blood loss,sufficient exposure is good for the reduction and stable fixation of fractures in the operation,early functional exercise can be proformed after operation,reverse Judet approach is a safe and efficient choice for the surgical treatment of scapular body complicated fractures.