移位不稳定性肩胛骨骨折的手术治疗策略

目的探讨移位不稳定性肩胛骨骨折的手术方法及疗效。方法 2006年1月-2011年3月应用钛合金重建钢板和/或空心螺钉治疗37例移位不稳定性肩胛骨骨折,男性28例,女性9例;年龄23～68岁,平均36.5岁。均行X线检查,其中32例行三维CT重建。手术切口采用标准Judet入路21例和肩胛骨外侧缘入路16例。结果随访10～39个月,平均25.4个月。术后X线片均示复位满意。所有骨折均愈合,愈合时间10～22周。按照Hardegger肩关节功能评定标准,优20例,良13例,可4例,优良率为89.2%。结论对于移位严重的肩胛骨骨折强调手术内固定,同时应依据骨折类型选择手术入路和内固定方式。因重建钢板和空心螺钉固定可靠,允许早期锻炼,临床效果满意。

Strategy of Surgical Treatment for Displaced Unstable Scapular Fractures

Objective To explore the operative treatments and outcomes of open reduction and fixation for the displaced unstable scapular fractures.Methods From January 2006 to March 2011,37 patients with displaced unstable scapular fractures were treated by open surgical operation with titanium alloy reconstruction plates and/or hollow screws(28 males and 9 females,with the mean age of 36.5 years).All patients were examined by conventional radiography and 32 cases also by three-dimensional spiral CT reconstruction.Twenty-one patients were treated through the standard Judet approach and 16 patients through lateral approach.Results All patients were followed up from 10 to 39 months with the average of 25.4 months.X-ray examination results showed satisfactory postoperative reduction.All cases were cured within 10 to 22 weeks after operation.According to Hardegger functional assessment system,the clinical results were excellent in 20 cases,good in 13 cases and fair in 4 cases.The excellent and good result was 89.2%.Conclusion The open reduction and internal fixation are the effective and safe technique for the treatment of specific displaced fractures of scapula.Suitable surgical approaches and internal fixation methods are performed according to the classification of fractures.Internal fixation by reconstruction plate and hollow screw can led to a good functional outcome because it provides stable fixation and allows early mobilization.