通过Judet入路对Ideberg IV型和V型关节内盂肱关节骨折进行切开复位内固定：11例回顾性分析

Open reduction and internal fixation of Ideberg IV and V glenoid intra-articular fractures through a Judet approach: a retrospective analysis of 11 cases.

作者信息

Hu Chuanzhen, Zhang Weibin, Qin Hui, Shen Yuhui, Xue Zichao, Ding Haoliang, An Zhiquan

机构信息

Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Ruijin Hospital, Shanghai, 200233, China.

Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.

出版信息

Arch Orthop Trauma Surg. 2015 Feb;135(2):193-199. doi: 10.1007/s00402-014-2129-y. Epub 2014 Dec 11.

DOI:10.1007/s00402-014-2129-y

PMID:25500966

Abstract

OBJECTIVES

To evaluate the methods and the outcomes of complex intra-articular glenoid fractures, treated by open reduction and internal fixations.

METHODS

The outcomes of 11 cases of complex intra-articular glenoid scapular fractures were retrospectively analyzed. The fractures were classified as type IV in five cases, type Va in two and Vb in four cases, according to Ideberg classification system. The mean step or gap between the main articular fragments was 6.3 ± 6.2 (4-25) mm. The fractures were openly reduced through a Judet approach and fixed with reconstructive plates or bands placed on the lateral and medial side of affected scapula, respectively. The main articular fragments were strengthened with a 4.0-mm cannulated screw in five cases. The bone union, the anterior flexion, the external and internal rotation of the shoulders were checked and recorded. The functional outcomes were evaluated using DASH questionnaire, Constant and UCLA shoulder score systems, respectively.

RESULTS

11 patients were followed up with an average of 28.2 ± 12.6 (12-50) months. All the fractures were united smoothly without second intervention. At the latest visiting, the mean anterior flexion of affected shoulder was 157.3 ± 7.37° (range 150°-170°), the mean external rotation of the affected shoulder was 58.2 ± 7.5° (range 50°-70°). When the shoulder in the internal rotation, the extended thumb reached to L4 or L1 or T10 or T7 in one case, to T12 in two cases and to T8 in four cases, respectively, the mean Constant score was 91.7 ± 2.8 (86-96) points. The mean UCLA score was 32.7 ± 1.7 (30-35) points, leading to four cases of excellent and seven cases of good results. The mean DASH score was 7.4 ± 3.3 (3.4-13) points.

CONCLUSION

Good outcomes could be obtained when Ideberg IV and V glenoid fractures were treated by open reduction and internal fixation through a Judet approach.

摘要

目的

评估切开复位内固定治疗复杂关节内肩胛盂骨折的方法及疗效。

方法

回顾性分析11例复杂关节内肩胛盂骨折的治疗结果。根据Ideberg分类系统，5例为IV型骨折，2例为Va型骨折，4例为Vb型骨折。主要关节碎片之间的平均台阶或间隙为6.3±6.2（4 - 25）mm。通过Judet入路切开复位骨折，分别用重建钢板或带环固定于患侧肩胛的外侧和内侧。5例患者用4.0mm空心螺钉加强主要关节碎片。检查并记录骨愈合情况、肩部前屈、外旋和内旋情况。分别采用DASH问卷、Constant和UCLA肩关节评分系统评估功能结果。

结果

11例患者平均随访28.2±12.6（12 - 50）个月。所有骨折均顺利愈合，无需二次干预。末次随访时，患侧肩部平均前屈为1�7.3±7.37°（范围150° - 170°），患侧肩部平均外旋为58.2±7.5°（范围50° - 70°）。当肩部内旋时，1例患者伸直的拇指分别达到L4或L1或T10或T7，2例患者达到T12，4例患者达到T8，Constant评分平均为91.7±2.8（86 - 96）分。UCLA评分平均为32.7±1.7（30 - 35）分，优4例，良7例。DASH评分平均为7.4±3.3（3.4 - 13）分。