肩胛骨外侧缘入路治疗肩胛骨颈部及体部骨折的疗效评价

摘要

目的 评价肩胛骨外侧缘入路治疗肩胛骨颈部及体部骨折的临床疗效.方法 回顾性分析昆明市第一人民医院甘美国际医院骨科2005年12月~2015年12月手术治疗的肩胛骨颈部及体部骨折患者78例,其中采取外侧缘入路手术治疗56例,男性32 例,女性24例;年龄20~58岁,平均38.2岁;道路交通伤42例,高处坠落伤8例,重物砸伤4例,其他伤2例.传统Judet入路手术治疗22例,男性13例,女性9例;年龄22~61岁,平均41.5岁;道路交通伤16例,高处坠落伤3例,重物砸伤2例,其他伤1例.分析两种入路在手术时间、失血量,术后3、12个月美国肩肘外科协会评分系统(ASES)肩关节功能评分的差异.结果 肩胛骨外侧缘入路手术时间(82.5±7.1)min,出血量(225.3±13.6)mL;传统Judet入路手术时间(115.7±8.9)min,出血量(413.6±16.7)mL,两组比较具有显著性差异(P<0.05).肩胛骨外侧缘入路术后3个月肩关节功能评分分别为疼痛(30.1±4.3)分、稳定性(33.4±2.8)分、功能(26.5±1.3)分,传统Judet入路分别为疼痛(24.6±5.1)分、稳定性(30.9±4.5)分、功能(21.5±3.6)分,两组比较具有显著差异(P<0.05);而12个月后两组肩关节功能评分在疼痛上差异显著(P<0.05),稳定性和功能上差异性不显著(P>0.05).结论 肩关节外侧切口治疗肩胛骨颈部及体部骨折与传统入路比较创伤小、手术时间短、出血少,术后早期对肩关节功能影响小,值得临床优先采用.%Objective To evaluate the curative effect of lateral scapula border approach on scapula neck and body fracture.Methods Seventy-eight cases of scapula neck and body fracture in the First People's Hospital of Kunming Luscious International Hospital from Dec.2005 to Dec.2015 were selected and were retrospectively analyzed,among whom 56 cases used lateral scapula border approach and 22 cases used Judet approach.In the lateral scapula border approach group,there were 32 males and 24 female,with age ranging from 20 to 58 (average,38.2) years.For the injury causes,42 cases were caused by traffic injury,8 caused by high falling injury,4 caused by bruise injury,and 2 caused by other factors.In the Judet approach group,there were 13 males and 9 females,with age ranging from 22-61 (average,41.5) years.For the injury causes,16 cases were caused by traffic injury,3 caused by high falling injury,2 caused by bruise injury,and 1 caused by other factors.The operation time,blood loss,ASES at 3 months and 12 months after operation were assessed between the two groups.Results The operation time,amount of bleeding of the lateral scapula border approach group were (82.5±7.1) min and (225.3±13.6) mL;while were (115.7±8.9) min and (413.6±16.7) mL in the Judet approach group.By means of statistics analysis,there was significant statistical difference between the two groups (P<0.05).The scores of ASES in pain,stability and function at 3 months after operation in the lateral scapula border approach group were (30.1±4.3),(33.4±2.8) and (26.5±1.3),respectively.The scores of ASES in pain,stability and function at 3 months after operation in the Judet approach group were (24.6±5.1),(30.9±4.5) and (21.5±3.6),respectively.According to statistic analysis,there was significant difference between the two groups (P<0.05);and the score of ASES in pain at 12 months after operation was significantly different (P<0.05),but had no significant difference in stability and function (P>0.05).Conclusion The lateral scapula border approach has obvious advantages over Judet approach in trauma,operation time,bleeding amount,and shoulder joint function.