改良肩后入路手术治疗肩胛骨骨折.docVIP

改良肩后入路手术治疗肩胛骨骨折 　　作者：王建，周跃，张正丰，初同伟，张峡 　(第三军医大学新桥医院骨科，重庆 400037) 　　摘要：目的 介绍肩胛骨骨折手术的改良后入路，分析手术治疗肩胛骨骨折的临床发现和结果。方法 11例肩胛骨骨折接受改良后入路切开复位内固定手术，其中5例肩胛盂骨折，3例肩胛颈骨折，2例肩胛体骨折，1例肩胛颈、盂和体部复杂型骨折。术后随访5～68个月，平均23.9个月。按Constant和Murley提出的评分方法评价患肩功能。结果 7例优，2例良，2例可。7例无肩部疼痛，7例肩部外展和屈曲130°，外展肌力4+～5级;6例恢复伤前工作，2例主妇能够完成家务。本组病例无术后并发症。结论 改良肩后入路是一种治疗肩胛骨骨折的有效手术入路，切开复位内固定及其术后早期康复锻炼，能够成功防止肩胛骨骨折并发肩部疼痛、僵硬和功能障碍。 　　关键词：手术入路;肩胛骨骨折;内固定 　　Modified posterior approach to surgical treatment of scapular fractures 　　WANG Jian,ZHOU Yue,ZHANG Zhengfeng,et al. 　　(Department of Orthopaedics,Xinqiao Hospital,Third Military Medical University,Chongqing 400037,China) 　　Abstract：Objective To introduce a modified posterior approach for scapular fracture and analyse the clinical findings and results of patient treated surgically for scapular fracture.Methods Eleven cases with scapular fractures were treated by a modified posterior approach,open reduction and internal fixation.Five patients had scapular glenoid fractures,3 cases had scapular neck fractures,2 cases had scapular body fractures,1 case had scapular neck,glenoid and body fractures characteristic of the complicated type.The mean followup period was 23.9 months (range 568 months).Functional evaluations were made according to the scoring system described by Constant and Murley.Results The results were excellent in 7 cases,good in 2 cases,and fair in 2 cases.Seven cases did not complaine of any pain,6 cases returned to preinjury jobs,2 cases who were housewives were able to do their housework.The range of shoulder movement was greater than 130° in both abduction and flexion,and the abduction muscle strength was 4+～5 grade in 7 cases.No postoperative complications were encountered.Conclusion The modified posterior approach is an effective operative approach to scapular fractures,and open reduction and stabilization followed by early rehabilitation is successful in preventing stiffness,pain and disability complicated by scapular fractures.