改良Judet入路微创手术治疗不稳定肩胛骨骨折

目的探讨改良Judet入路微创手术治疗不稳定肩胛骨骨折的疗效。方法回顾性分析自2013-04—2016-03诊治的60例肩胛骨骨折,采用经典Judet入路手术治疗30例(对照组),采用改良Judet入路附加肌间小切口手术治疗30例(观察组)。比较2组切口长度、手术时间、术中出血量,术后3 d疼痛VAS评分,术后3个月内并发症发生情况,以及术后1、3个月肩关节功能Herscovici评分。结果与对照组相比,观察组切口长度、手术时间更短,术中出血量更少,术后3 d疼痛VAS评分更低,差异有统计学意义(P0.05)。60例均获得随访5~22个月,平均13个月。观察组并发症发生率明显低于对照组,差异有统计学意义(P0.05)。观察组术后1、3个月肩关节功能Herscovici评分优良率均高于对照组,但差异无统计学意义(P0.05)。结论采用改良Judet入路附加肌间小切口显露骨折端、解剖复位骨折、个性化钢板内固定肩胛骨边缘治疗不稳定肩胛骨骨折,术中损伤小,术后并发症少、疼痛轻,有利于患者早期进行系统的康复训练,肩关节功能恢复良好。

Effects of modified Judet approach minimally invasive surgery on fracture of scapula

Objective To investigate the effect of surgical treatment on unstable fractures of scapula with minimally invasive modified Judet approach.Methods The diagnosis and treatment of 60 patients with scapular fractures from April 2013 to March 2016 in our department was analyzed retrospectively.Thirty cases in the observation group were treated by surgical methods using minimally invasive modified Judet approach while 30 cases in the control group using the classical Judet approach.The incision length,operation time,intraoperative blood loss,VAS pain score 3 days after operation,complications within 3 months after operation,and shoulder function Herscovici score of the 1 and 3 months after operation were compared between the 2 groups.Results Compared with the control group,the incision length and operation time were shorter,intraoperative bleeding and VAS pain score 3 days after operation were less in the observation group,the difference was statistically significant (P ＜0.05).All the 60 patients were followed up for 5-22 months,with an average of 13 months.The complication rate of the observation group was lower than that of the control group,the difference was statistically significant (P ＜0.05).The excellent rate of shoulder function Herscovici score in observation group 1 and 3 months after operation was higher than that in control group,the difference was not statistically significant (P ＞0.05).Conclusion The combination of modified Judet approach and intramuscular small incision to expose fractures,anatomical reduction,and fixation of edge of the scapula with personalized plate can reduce operative trauma,postoperative complications and postoperative pain,and it is beneficial for early systemic rehabilitation training and good functional recovery of shoulder joint.