CAJ | 학술논문

目的比较直切口与Judet入路治疗肩胛骨颈部、体部骨折的疗效.方法回顾性分析2001年7月至2011年7月采用直切口与Judet入路治疗32例肩胛骨颈部、体部骨折患者资料.其中采用直切口入路15例,男11例,女4例；年龄32～44岁,平均38.10岁；骨折Ada-Miller分型,ⅡA型4例,ⅡB型6例,Ⅳ型5例.采用Judet入路17例,男12例,女5例；年龄32～45岁,平均39.47岁；骨折Ada-Miller分型,ⅡA型5例,ⅡB型4例,Ⅳ型8例.对两组患者的术中情况、术后疼痛视觉模拟评分(visual analogue score,VAS)进行比较,并采用Rowe-Zarins评分系统及Constant-Murley功能评分对术后肩关节功能进行评估.结果所有骨折均在术后8周内初步愈合,无一例发生切口感染、内固定松动及断裂、肩关节畸形等并发症.直切口入路组与Judet入路组手术切口分别为(6.73±0.96) cm和(18.88±1.41) cm,手术时间为(58.67±4.39) min和(82.24±4.49) min,出血量为(94.25±6.14) ml和(227.77±23.08) ml,术后疼痛VAS评分是(2.60±1.55)分和(4.65±1.93)分,两组轻、中度疼痛比较差异有统计学意义.术后1年直切口与Judet入路组的Rowe-Zafins疗效评价优良率为93.3％(14/15)和88.2％(15/17),两者比较差异无统计学意义.Constant-Murley功能评分中肩关节活动度和肌力评分,两组比较差异无统计学意义；但疼痛和日常生活评分,两组比较差异有统计学意义；Constant-Murley功能的总评分,直切口入路组与Judet入路组分别为(85.60±3.31)分和(80.65±3.44)分.结论直切口入路治疗肩胛骨颈部、体部骨折,较传统Judet入路手术时间短、手术损伤小、术后疼痛轻、术后功能恢复好,是手术治疗肩胛骨颈部、体部骨折的较好入路.
목적 비교직절구여Judet입로치료견갑골경부、체부골절적료효.방법 회고성분석2001년7월지2011년7월채용직절구여Judet입로치료32례견갑골경부、체부골절환자자료.기중채용직절구입로15례,남11례,녀4례；년령32～44세,평균38.10세；골절Ada-Miller분형,ⅡA형4례,ⅡB형6례,Ⅳ형5례.채용Judet입로17례,남12례,녀5례；년령32～45세,평균39.47세；골절Ada-Miller분형,ⅡA형5례,ⅡB형4례,Ⅳ형8례.대량조환자적술중정황、술후동통시각모의평분(visual analogue score,VAS)진행비교,병채용Rowe-Zarins평분계통급Constant-Murley공능평분대술후견관절공능진행평고.결과 소유골절균재술후8주내초보유합,무일례발생절구감염、내고정송동급단렬、견관절기형등병발증.직절구입로조여Judet입로조수술절구분별위(6.73±0.96) cm화(18.88±1.41) cm,수술시간위(58.67±4.39) min화(82.24±4.49) min,출혈량위(94.25±6.14) ml화(227.77±23.08) ml,술후동통VAS평분시(2.60±1.55)분화(4.65±1.93)분,량조경、중도동통비교차이유통계학의의.술후1년직절구여Judet입로조적Rowe-Zafins료효평개우량솔위93.3％(14/15)화88.2％(15/17),량자비교차이무통계학의의.Constant-Murley공능평분중견관절활동도화기력평분,량조비교차이무통계학의의；단동통화일상생활평분,량조비교차이유통계학의의；Constant-Murley공능적총평분,직절구입로조여Judet입로조분별위(85.60±3.31)분화(80.65±3.44)분.결론 직절구입로치료견갑골경부、체부골절,교전통Judet입로수술시간단、수술손상소、술후동통경、술후공능회복호,시수술치료견갑골경부、체부골절적교호입로.
Objective To compare the clinical effect for treatment of scapula neck or body fractures by straight incision approach and the Judet approach.Methods From July 2001 to July 2011,32 patients with scapula neck or body fractures were treated using the two different approaches:(1) the straight incision approach in 15 patients including 11 males and 4 females,the average age of 38.10 years,fractures classified by Ada-Miller including 4 ⅡA,6 ⅡB and 5 Ⅳ; (2) the Judet approach in 17 patients including 12 males and 5 females,the average age of 39.47 years,fractures classified by Ada-Miller including 5 ⅡA,4 ⅡB and 8 Ⅳ.All patients were followed up.Intraoperative data and postoperative pain of two groups were compared by visual analogue score (VAS),the efficacy were evaluated by Rowe-Zarins scores and the patient's postoperative shoulder function were assessed by Constant-Murley functional score.Results All fractures were preliminary healed after 8 weeks of surgery,there was no wound infection,no internal fixation loosening,no shoulder deformity and other complication.Length of incision,operative time and blood loss of straight incision approach was 6.73±0.96 cm,58.67±4.39 min,94.25±6.14 ml and length of incision,operative time and blood loss of Judet approach was 18.88±1.41 cm,82.24±4.49 min,227.77±23.08 ml.VAS of straight incision approach and Judet approach were 2.60±1.55 and 4.65±1.93,mild and moderate postoperative pain evaluated by VAS were significant differences between two groups.The excellent rate by Rowe-Zarins scores of straight incision approach and Judet approach were 93.3％(14/15) and 88.2％(15/17),they were no significant differences.There was no significant differences in the shoulder joint mobility and muscle strength of Constant-Murley functional score between two groups.However,pain and daily life of Constant-Murley functional score were significant differences between two groups and Constant-Murley functional score of straight incision approach and Judet approach were 85.60±3.31 and 80.65±3.44.Conclusion Compared with Judet approach,straight in cision approach has many advantages,such as a short time of surgery,minor injury,light postoperative pain,good postoperative functional recovery.It is the better surgical approach for the treatment of scapular fractures.