对经腋窝入路手术治疗部分肩胛骨骨折的疗效分析

Analysis on the effect of axillary approach in the treatment of sectional scapula fractures

目的 探讨腋窝入路手术治疗肩胛盂下部骨折及部分肩胛骨体部骨折的临床疗效。方法选取2019年1月至2021年6月唐山市第二医院骨科采用经腋窝入路手术治疗的肩胛骨骨折患者18例;16例获得完全随访。记录手术时间、术中出血、术后疼痛、骨折愈合时间,并进行疼痛视觉模拟评分(VAS)、CM肩关节评分、UCLA肩关节评分和DASH上肢功能评分评价,分析疗效。结果 所有患者术后伤口全部顺利愈合;且均获得骨性愈合,无腋神经麻痹发生。骨折愈合时间为(2.2±0.4)个月。术中出血(218.8±87.3)ml。术后第1天VAS为(5.1±1.4)分;手术时间为(76.3±15.9)min;前屈上举(151.3±12.0)°;外展上举(158.8±13.1)°;外旋(46.9±13.0)°;内旋达到L3水平3例,达到T12水平4例,达到T10水平7例,达到T8水平2例。术后CM肩关节功能评分为(91.3±3.5)分;UCLA肩关节评分为(32.5±1.9)分;DASH上肢评分为(7.9±4.2)分。结论 腋窝入路手术是治疗肩胛骨骨折的好方法;尤其是治疗肩胛盂下半部骨折可达到预期的效果,为临床提供了新的治疗选择。

Objective To investigate the clinical effect of axillary approach in the treatment of subscapular fractures and sectional scapula body fractures.Methods From January 2019 to June 2021,18 patients with scapular fractures were treated by operation via axillary approach in Department of Orthopedics,the Second Hospital of Tangshan;16 patients were fully followed up.The operation time,intraoperative bleeding,postoperative pain,and fracture healing time were recorded;VAS,CM shoulder joint scores,UCLA shoulder joint scores,and DASH upper limb function scores were evaluated to analyze the curative effect.Results All patients achieved bone healing without axillary nerve paralysis and all wounds healed smoothly after operation.The average healing time of fracture was(2.2±0.4)months;the intraoperative bleeding was(218.8±87.3)ml;the VAS scores on the first day after operation were(5.1±1.4);the operation time was(76.3±15.9)minutes;the anteflexion and upward lifting was(151.3±12.0)°;the abduction and upward lifting was(158.8±13.1)°;the external rotation was(46.9±13.0)°.The internal rotation was L3 3 cases,T12 4 cases,T10 7 cases,T8 2 cases.The post-operation CM shoulder joint function scores were(91.3±3.5)points;the post-operation UCLA shoulder joint scores were(32.5±1.9)points;the postoperative DASH scores of upper limb were(7.9±4.2).Conclusion The method through axillary approach for the treatment of scapular fracure has achieved the desired effect,especially in the fracture of the lower half of the glenoid bone.It can provide a new choice for clinical treatment.