改良Judet手术入路治疗复杂肩胛骨骨折

目的探讨改良Judet手术入路治疗复杂肩胛骨骨折的适应证及疗效。方法自1997年1月至2005年10月经改良Judet手术入路治疗肩胛骨骨折21例,其中男性15例,女性6例,平均年龄34岁（18～62岁）。根据Hardegger的分型方法,肩胛体部骨折11处、肩胛颈骨折10处、盂缘骨折8处、盂窝骨折7处、肩胛冈骨折9处、肩峰骨折6处。其中多部位复杂骨折15例,伴有腋神经损伤2例,肩胛上神经损伤4例。通过改良Judet手术入路,对不同类型的肩胛骨骨折使用重建钢板或拉力螺钉等固定。结果18例患者获得随访,随访时间6个月至4年,平均21个月。根据Rowe疗效评价标准,优12例,良3例,可2例,差1例,优良率为83％。结论改良Judet入路操作简单,暴露充分,大多数类型的肩胛骨骨折可通过改良Judet入路完成,尤其适用于肩胛体部骨折,肩胛颈骨折,肩胛冈骨折以及不存在喙突、前部肩胛盂骨折的多部位复杂骨折,经改良Judet入路行骨折复位内固定是肩胛骨骨折手术治疗的一种安全有效方法。

Operative treatment of the scapular fractures through modified Judet approach

Objective To investigate the effect of operative treatment of scapular fractures through modified Judet approach.Methods From January 1997 to October 2005, 21 patients (15 females, 6 males; mean age 34 years) of scapular fractures were treated by open reduction and internal fixation through the modified Judet approach. According to Hardegger classification system, there were 11 patients of scapular body fractures, 10 patients of scapular neck fractures, 8 patients of glenoid rim fractures, 7 patients of glenoid fossa fractures, 9 patients of scapular spine fractures, and 6 patients of scapular acromion fractures.Results Eighteen patients were followed up with an average of 21 months(range 6 months-4 years). According to Rowe scores system, 12 patients showed excellent, 3 showed good, 2 showed fair, and 1 showed poor.Conclusions The modified Judet approaches have the advantages of wide exploration, safety, and easy fixation. It is a good choice to the operation for most types of scapular fractures through the modified Judet approach.