经腋窝入路治疗肩胛盂骨折的疗效分析

Treatment of scapular glenoid fracture through axillary approach

目的探讨经腋窝入路治疗肩胛盂骨折的疗效。方法回顾性分析2019年11月至2021年4月郑州市骨科医院上肢骨科收治的12例肩胛盂骨折患者资料,男4例,女8例;年龄30~75岁,平均53.5岁。肩胛盂骨折按照Ideberg分型:Ⅰa型2例,Ⅱ型9例,Ⅴa型1例。所有患者均采用腋窝入路治疗,2例合并肩关节前脱位患者均于麻醉下先行手法复位,2例IdebergⅠa型患者使用锚钉固定,余10例患者使用腋窝入路专用接骨板固定,3例合并大结节骨折患者均经肩外侧劈三角肌入路使用大结节专用接骨板固定。末次随访时分别采用肩关节Constant-Murley评分、视觉模拟评分(VAS)、Hawkins分级分别对患者治疗后肩关节功能、疼痛及稳定性进行评价。结果术后所有患者获9~20个月(平均14.4个月)随访;手术时间为55~110 min,平均76.3 min;术中出血量为60~160 mL,平均103.8 mL;住院时间为8~14 d,平均11.1 d。所有患者手术切口均为甲级愈合。术后6个月肩胛盂均获骨性愈合。末次随访时所有患者均无肩关节不稳、血管神经损伤、内固定物松动或断裂。末次随访时,肩关节活动度:前屈159.2°±26.1°,外展156.7°±29.6°,外旋(中立位)48.3°±15.3°,内旋(中立位)73.3°±12.3°;肩关节Constant-Murley评分为(94.0±5.3)分。末次随访时肩关节各方向活动度及Constant-Murley评分较术前[10.8°±11.6°、7.5°±11.4°、5.8°±10.0°、42.5°±16.0°、(4.9±4.0)分]显著改善,差异均有统计学意义(P<0.05)。末次随访时疼痛VAS评分0分11例,2分1例。结论经腋窝入路治疗肩胛盂骨折,手术创伤小,切口隐蔽美观,可以取得良好的临床疗效,是一种可行的手术方式。

Objective To evaluate the clinical efficacy of the axillary approach in the treatment of scapular glenoid fracture.Methods A retrospective analysis was performed of the 12 patients who had been treated for scapular glenoid fracture from November 2019 to April 2021 at Department of Upper Limb Orthopaedics,Zhengzhou Orthopaedic Hospital.They were 4 males and 8 females,aged from 30 to 75 years(mean,53.5 years).According to the Ideberg classification,there were 2 cases of typeⅠa,9 cases of typeⅡand one case of typeⅤa.All cases were treated through the axillary approach.Two patients complicated with anterior shoulder dislocation were treated with manual reduction under anesthesia before operation and the other 10 cases with special plate fixation through the axillary approach.The 3 patients complicated with fracture of greater tuberosity were fixated with a special plate through the lateral shoulder split deltoid approach.Constant-Murley score,visual analogue scale(VAS)and Hawkins grading were used at the last follow-up to evaluate shoulder function,pain and stability after operation.Results All patients were followed up for 9 to 20 months(mean,14.4 months).The operation time ranged from 55 to 110 min(mean,76.3 min),intraoperative bleeding from 60 to 160 mL(mean,103.8 mL),and hospital stay from 8 to 14 d(mean,11.1 d).All incisions healed primarily and all scapular glenoid fractures got united 6 months after operation.The last follow-up showed no shoulder instability,neurovascular injury or internal fixation failure.At the last follow-up,the range of motion of the shoulder was 159.2°±26.1°in forward bending,156.7°±29.6°in abduction,48.3°±15.3°in external rotation(neutral position),and 73.3°±12.3°in internal rotation(neutral position),and the Constant-Murley score was(94.0±5.3)points.The range of motion of the shoulder and Constant-Murley score were significantly improved compared with those before operation(10.8°±11.6°,7.5°±11.4°,5.8°±10.0°,42.5°±16.0°and 4.9±4.0,respectively)(all P<0.05).The VAS score was 0 in 11 patients and 2 in one patient at the last follow-up.Conclusion The axillary approach is feasible for the treatment of scapular glenoid fracture,because it is hidden and less invasive,leading to good clinical outcomes.