CAJ | 학술논문

目的探讨双入路切开复位双重建钛板内固定治疗不稳定型肩胛颈骨折的近期疗效.方法回顾性分析2005年9月至2010年9月采用双入路切开复位内固定治疗并获完整随访的13例肩胛颈骨折患者资料,男10例,女3例；年龄19 ～52岁,平均35.3岁.按Euler等分型方法将肩胛颈骨折分为:解剖颈骨折3例,外科颈骨折10例(A型7例,B型3例).所有患者均使用3.5 mm重建钛板和螺钉固定.通过肩胛骨前位X线片测量肩胛盂成角和盂极角(GPA).末次随访时根据Constant-Murley评分和Herscovici功能评分评定肩关节功能. 结果 13例患者术后获6～ 37个月(平均16.2个月)随访.骨折复位质量:解剖复位11例,接近解剖复位2例.术后7～9d切口均一期愈合.术后平均肩胛盂成角(27.1°)与GPA(36.2°)均较术前(55.1°、17.1°)有所改善.骨折临床愈合时间为6～12周,平均8周.末次随访时Constant-Murley评分平均为79.6分(54 ～ 95分),其中优9例,良3例,差1例；Herscovici功能评分平均为14.7分(12～16分):优8例,良2例,可2例,差1例.无肩胛上动脉神经损伤、感染、血肿形成等并发症发生. 结论双入路切开复位双重建钛板内固定治疗不稳定型肩胛颈骨折可达到解剖复位、稳定内固定和满意的近期疗效.
목적 탐토쌍입로절개복위쌍중건태판내고정치료불은정형견갑경골절적근기료효.방법 회고성분석2005년9월지2010년9월채용쌍입로절개복위내고정치료병획완정수방적13례견갑경골절환자자료,남10례,녀3례；년령19 ～52세,평균35.3세.안Euler등분형방법장견갑경골절분위:해부경골절3례,외과경골절10례(A형7례,B형3례).소유환자균사용3.5 mm중건태판화라정고정.통과견갑골전위X선편측량견갑우성각화우겁각(GPA).말차수방시근거Constant-Murley평분화Herscovici공능평분평정견관절공능. 결과 13례환자술후획6～ 37개월(평균16.2개월)수방.골절복위질량:해부복위11례,접근해부복위2례.술후7～9d절구균일기유합.술후평균견갑우성각(27.1°)여GPA(36.2°)균교술전(55.1°、17.1°)유소개선.골절림상유합시간위6～12주,평균8주.말차수방시Constant-Murley평분평균위79.6분(54 ～ 95분),기중우9례,량3례,차1례；Herscovici공능평분평균위14.7분(12～16분):우8례,량2례,가2례,차1례.무견갑상동맥신경손상、감염、혈종형성등병발증발생. 결론 쌍입로절개복위쌍중건태판내고정치료불은정형견갑경골절가체도해부복위、은정내고정화만의적근기료효.
Objective To discuss the short-term outcomes of open reduction and two-portal approach internal fixation of unstable scapular neck fractures with double reconstruction titanium plates.Methods Thirteen patients with unstable scapular neck fracture were operatively treated in our department from September 2005 to September 2010.They were 10 men and 3 women,aged from 19 to 52 years (average,35.3 years).According to Euler' classification,there were 3 anatomical neck fractures and 10 surgical neck fractures (7 cases of type A and 3 cases of type B).All patients were fixated with double titanium reconstruction plates of 3.5 mm and screws.The software Digimizer3.1.1.0 was used to measure the glenoid angulations and the glenopolar angles (GPA) on the anterior scapular X-ray films.Shoulder functions were assessed by the Constant-Murley score and Herscovici score at the last follow-up.Results The 13 patients were followed up from 6 to 37 months (average,16.2 months).Anatomic reduction was achieved in 11 cases and almost anatomic reduction in 2.All incisions healed at one stage 7 to 9 days after surgery.The preoperative GA and GPA improved from 55.1° and 17.1° respectively to 27.1° and 36.2° post-operation.Clinical union of the fractures was achieved in a period from 6 to 12 weeks (average,8 weeks).At the last follow-up,the average Constant-Murley score was 79.6 points (from 54 to 95 points),with 9 excellent,3good and one poor cases; the average Herscovici score was 14.7 points (from 12 to 16 points),with 8 excellent,2 good,2 fair and one poor cases.No injury to the suprascapular arteries and nerves,infection or haematoma formation occurred.Conclusion Open reduction and two-portal approach for internal fixation of unstable scapular neck fractures can lead to anatomic reduction,stable internal fixation and satisfactory short-term functional outcomes.