外侧切口入路桥接组合式内固定治疗肩胛骨骨折

目的:探讨采用外侧切口入路桥接组合式内固定系统治疗肩胛骨骨折的临床效果。方法:2012年10月至2016年12月,采用外侧切口入路桥接组合式内固定系统治疗20例肩胛骨骨折,男15例,女5例;年龄21~52岁,平均31.6岁。肩胛体骨折14处,肩胛颈骨折10处,肩胛冈骨折6处,肩峰骨折1处,喙突骨折1处,盂缘骨折4处,盂窝骨折3处。手术时间为伤后4~15 d,平均10 d。结果:所有患者获得随访,时间3~24个月,平均15个月。术后2例发生伤口感染,经伤口清创、换药后愈合,无骨髓炎、医源性神经损伤、内固定松动断裂、骨折再移位、关节僵硬等并发症发生。术后3个月骨折部位可见骨痂生长,骨折愈合时间为4~7个月,骨折愈合良好,无延迟愈合或畸形愈合。肩关节功能评定采用Hardegger评定标准:优12例,良6例,可2例。结论:肩胛骨外侧切口入路术中操作方便,显露清楚,该切口可任意向两边延长,能为骨折的复位固定提供有利条件。桥接组合式内固定系统术中操作灵活,固定强度可靠,是一种治疗肩胛骨骨折的良好选择。

Treatment of scapular fractures with lateral incision and bridge combined internal fixation system

Objective:To investigate the clinical results of scapula fractures with lateral incision combined with bridge internal fixation system.Methods:From October 2012 to December 2016,20 cases of scapular fractures were treated through the lateral incision combined with bridge fixation system,including 15 males and 5 females,with an average age of 31.6 years old(ranged,21 to 52 years old). Fourteen cases were scapular body fracture,10 were scapular neck fracture,6 were scapular fracture,1 was acromion fracture,1 was coracoid fracture,4 were the glenoid rim fracture,3 were the glenoid fossa fracture. The operation time ranged from 4 to 15 d after injury with an average of 10 d.Results:All 20 cases were followed up for 3 to 24 months with an average of 15 months. Wound infection occurred in 2 cases after operation,and was healed after wound debridement and change dressing;no osteomyelitis,iatrogenic nerve injury,breakage of internal fixation,fracture displacement,joint stiffness occurred. Callus growth was observed at the fracture site 3 months after operation,the fracture healing time was 4 to 7 months,fracture healing was good without delayed union or malunion. According to Hardegger shoulder score,the results were excellent in 12 cases,good in 6 cases,moderate in 2 cases.Conclusion:Lateral incision approach combined with bridge internal fixation system for scapula fractures has the advantages of easy operation,revealed clearly,and the incision can be arbitrary to extend on both sides,to provide favorable conditions for the reduction and fixation of fracture. Bridge combined internal fixation system has the advantages of flexible operation,reliable fixation strength,is a good choice for treatment of scapula fracture.