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浙江大学学报（医学版）
J Zhejiang Univ (Med Sci)  2019, Vol. 48 Issue (6): 651-656    DOI: 10.3785/j.issn.1008-9292.2019.12.10
    
Internal fixation of lateral and medial borders for displaced scapular body fractures via minimally invasive approach: results of 23 cases
GAO Mingxuan(),NIE Dejun,CHANG Yanfeng,XIE Weiqiang,WANG Yue,PU Xingyu,ZHANG Wei,LUO Wenyuan*()
Third Department of Orthopedics, Gansu Provincial Hospital, Lanzhou 730000, China
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Abstract  

Objective: To evaluate the efficacy of internal fixation of lateral and medial borders for displaced scapular body fractures via the minimally invasive approach. Methods: The internal fixation of lateral and medial borders via minimally invasive approach was applied in surgical treatment of 23 patients with scapular body comminuted fractures from January 2014 to June 2018. The lateral approach was made straightly orienting over the lateral border of scapula. The dissection was taken down to the deltoid fascia. The deltoid was retracted cephalically, revealing the external rotators. Blunt dissection was used down to the lateral border between infraspinatus and teres minor, exposing the fracture site. The medial incision was done along the medial border of the scapula over site of the fracture. Dissections were taken down to the fascia and the periosteum. A subperiosteal dissection was then performed to elevate the infraspinatus to the degree necessary to visualize the fracture. The medial and lateral borders of scapula body were fixed with plates and screws in a frame-like way. Results: One patient developed the delayed healing of the incisions due to liquefactive fat necrosis. The other 22 patients showed no complications of the incisions. The glenopolar angle (GPA) of fractured scapula was increased from preoperative (25±12) degrees to postoperative (41±5) degrees (P < 0.01). The healing time of fractures healed was 3-8 months, with an average time of (4.4±1.3) months. Conclusion: The lateral-medial combined fixation through minimally invasive surgical approach for the scapula body fractures allows visualization of fracture reduction without extensive muscular or subcutaneous flaps, and is associated with successful fracture healing and high functional scores of the shoulder.

Key words： Fractures, bone/surgery      Scapula/injuries      Fracture fixation, internal/methods      Minimally invasive surgical procedures      Treatment outcome      Fractures, bone/surgery      Scapula/injuries      Fracture fixation, internal/methods      Minimally invasive surgical procedures      Treatment outcome     
Received: 30 June 2019      Published: 19 January 2020
CLC:  R683.41  
Corresponding Authors: LUO Wenyuan     E-mail: mingxuangao77@163.com;wenyuanluo1966@163.com
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GAO Mingxuan
NIE Dejun
CHANG Yanfeng
XIE Weiqiang
WANG Yue
PU Xingyu
ZHANG Wei
LUO Wenyuan
Cite this article:

GAO Mingxuan,NIE Dejun,CHANG Yanfeng,XIE Weiqiang,WANG Yue,PU Xingyu,ZHANG Wei,LUO Wenyuan. Internal fixation of lateral and medial borders for displaced scapular body fractures via minimally invasive approach: results of 23 cases. J Zhejiang Univ (Med Sci), 2019, 48(6): 651-656.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2019.12.10     OR     http://www.zjujournals.com/med/Y2019/V48/I6/651


内、外侧联合双柱内固定治疗23例肩胛骨体部移位骨折患者疗效分析

目的: 分析内、外侧微创切口双柱固定治疗肩胛骨体部移位骨折的临床疗效。方法: 2014年1月至2018年6月采用内、外侧微创切口手术治疗肩胛骨体部移位骨折患者23例。外侧切口：沿肩胛骨外侧缘、外柱骨折线向上牵开三角肌后部，自小圆肌与冈下肌间隙显露出肩胛骨外缘。内侧切口：沿肩胛骨内侧缘、内柱骨折线顺斜方肌纤维分离，经菱形肌与冈下肌肩胛骨附丽点间隙分离进入，显露肩胛骨内侧缘。两柱均用钢板螺丝钉进行框架式内固定。结果: 除1例患者的切口脂肪液化经二次处理后愈合，其余所有患者切口一期愈合。骨折肩胛骨盂极角术前为（25±12）°，术后为（41±5）°，差异有统计学意义（P < 0.01）。骨折愈合时间为3~8个月，平均（4.4±1.3）个月。结论: 采用内、外侧联合双柱内固定手术治疗肩胛骨体部移位骨折便于骨折显露、复位和可靠固定，且软组织剥离少，患者骨折愈合率高，功能恢复良好。


关键词： 骨折/外科学,  肩胛骨/损伤,  骨折固定术, 内/方法,  最小侵入性外科手术,  治疗结果,  骨折/外科学,  肩胛骨/损伤,  骨折固定术, 内/方法,  最小侵入性外科手术,  治疗结果 
例序 性别 年龄（岁） 致伤原因 肩胛骨骨折左/右侧 合并外伤 AO分型 Bartoníček分型 骨折描述
外柱移位（mm） 成角畸形（°） 盂极角GPA（°） 术后盂极角GPA（°）
AO：内固定研究协会.
1 男 74 10 m高处跌落 右 右2-8肋多发骨折，右肺挫伤 14B2 (l, m) D 18 35 15 38
2 男 49 重物砸伤 右 右3-7、左7-8多发肋骨骨折，双肺挫伤，胸8、11压缩骨折 14B2 (l, m，g) A 35 15 40 43
3 男 41 机动车相撞，司机 右 右腋部皮肤脱套、右肱骨干骨折、右臂丛损伤 14B2 (l, m) C 32 30 23 45
4 男 47 重物砸伤 右 右3-6多发肋骨骨折，右肺挫伤并胸腔积液 14B2 (l, m, g) C 23 35 31 41
5 女 55 行人被机动车撞伤 右 右1-4多发肋骨骨折，右肺挫伤并胸腔积液、肺不张；左眼外伤 14B2 (l, m, g) D 19 32 17 35
6 男 43 行人被机动车撞伤 右 右2-7多发肋骨骨折，右肺挫伤并胸腔积液、肺不张、气胸；肝挫伤，腹腔少量积液 14 B2 (l, m, g) C 33 15 13 38
7 女 60 3m高处跌落 左 无 14B2 (l, m) C 41 22 33 48
8 男 30 机动车相撞事故，乘客 左 左第4肋骨、左肺挫伤、胸腔积液，左L1-L4横突骨折，左髋臼骨折，右髋臼骨折 14B2 (l, m) C 50 45 20 45
9 男 52 13 m高处跌落 右 无 14B2 (l, m) D 25 35 22 39
10 女 64 行人被机动车撞伤 右 左肱骨大结节撕脱骨折并肩关节脱位 14B2 (l, m) C 22 13 32 47
11 男 49 重物砸伤 右 右3-7、左7-8多发肋骨骨折，双肺挫伤，胸8、11压缩骨折 14B2 (l, m，g) A 35 15 40 43
12 男 33 4m高处跌落 左 左7-9多发肋骨骨折，左肺挫伤，左侧气肺、肺不张 14B2 (l, m) D 31 10 22 38
13 男 48 3m高处跌落 左 无 14B2 (l, m) A 28 15 30 42
14 男 46 重物砸伤 左 无 14B2 (l, m) A 35 38 18 33
15 女 48 行人被机动车撞伤 左 左3-6多发肋骨骨折，左肺挫伤，左侧胸腔积液 14B2(l, m) C 22 40 45 50
16 男 39 机动车相撞事故，司机 右 右肺挫伤，右胸腔积液；左股骨粗隆间骨折 14B2(l, m) B 53 12 8 41
17 男 46 重物砸伤 左 无 14B2(l, m) A 21 9 46 47
18 男 61 3m高处跌落 左 左肺挫伤，左胸腔积液 14B2 (l, m) A 32 11 10 31
19 男 51 机动车翻车事故，乘员 左 双肺挫伤，双胸腔积液 14B2 (l, m) C 47 24 31 40
20 男 48 机动车相撞事故，司机 左 左5肋骨骨折，胸10压缩骨折 14B2 (l, m) A 33 16 13 45
21 男 39 机动车撞墙事故，司机 左 无 14B2 (l, m) A 38 10 7 36
22 男 33 重物砸伤 左 无 14B2 (l, m) A 44 22 11 42
23 男 51 机动车相撞事故，乘员 右 双侧5-7肋骨骨折，双胸腔积液，右股骨干骨的 14B2 (l, m，g) C 8 36 38 41
Table S1 Demographics and fracture characteristics of patients with fracture of scapula body
Fig 1 Typical case of internal fix lateral and medial borders of displaced scapular body fractures via the minimally invasive approach
例序 内侧/外侧切口（cm） 术中出血量（mL） 骨折愈合时间(月) 末次随访Constant-Murley评分 随访时间(月) 并发症
患侧 健侧
1 8/15 80 4 83 92 12 无
2 4/10 350 6 96 96 16 无
3 5/10 230 5 85 100 40 切口脂肪液化
4 4/6 100 8 87 96 14 无
5 5/7 130 6 78 94 16 无
6 4/8 200 4 87 100 23 无
7 4/10 60 4 81 87 54 无
8 4/14 100 3 94 100 10 无
9 8/13 90 3 92 96 12 无
10 4/8 200 5 83 73 22 内侧内固定刺激软组织
11 4/11 170 3 89 96 54 无
12 8/13 220 5 92 98 24 内侧内固定刺激软组织
13 5/10 100 4 100 100 12 无
14 4/8 80 5 96 98 32 无
15 5/7 80 4 88 92 13 无
16 6/11 230 4 96 100 31 无
17 4/7 100 3 98 100 23 无
18 5/12 250 4 92 96 18 无
19 4/10 300 5 88 92 22 无
20 4/10 150 3 98 98 50 无
21 5/9 80 3 100 100 46 无
22 5/10 130 4 96 98 44 无
23 8/17 550 6 88 92 23 无
Table S2 Operation and follow-up results of patients with scapular body fractures received internal fixation of lateral and medical borders via minimally invasive approach
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[1] 附表1-23例肩胛骨体部骨折患者的临床资料 Download
[2] 附表2-内、外侧联合双柱内固定治疗肩胛骨体部骨折患者的手术和随访信息 Download
[3] 本文所有附图附表下载 Download
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