Department of Orthopaedics, Waikato Hospital, Hamilton, New Zealand.
Department of Orthopaedics, Christian Medical College, Vellore, India.
J Shoulder Elbow Surg. 2018 Jul;27(7):1290-1296. doi: 10.1016/j.jse.2017.11.021. Epub 2018 Jan 2.
Scapula fractures are rare injuries that are generally treated nonoperatively. When surgery is performed, it is commonly undertaken through the posterior approach, which can be invasive and unforgiving on the soft tissues. We describe an alternative safe approach between teres major and minor that remains deep to a fascial sling formed by the combined infraspinatus and teres minor fasciae and deep to the primary nerve to teres minor, which is a terminal branch of the axillary nerve.
Between January 2008 and June 2014, there were 22 patients who underwent scapula fixation with this approach who were retrospectively identified and prospectively invited for clinical review by the American Shoulder and Elbow Surgeons (ASES) evaluation form and Constant score. Postoperative external rotation (ER) power in both abduction and adduction was also assessed.
Five patients were lost to follow-up. All of the remaining patients were male with a mean age of 44.5 years (28-66 years). Mean follow-up time was 34.7 months (3-72 months). The mean ASES score for the 17 patients was 86.6 (41.6-100); the mean Constant score was 89.3 (22-100). The only significant factor affecting the ASES score was an ipsilateral neurologic upper limb injury. ER power was improved or equivalent to the contralateral side in 8 of the 10 patients assessed for ER; it was weaker in 2 patients, both of whom had surgical fixation of the vertebral border of the scapula.
The inter-teres approach may be a safe alternative approach in glenoid fixation, although the loss of ER strength needs further evaluation.
肩胛骨骨折较为少见，通常采用非手术治疗。手术治疗时，通常采用后入路，这种方法对软组织具有侵袭性且不可避免。我们描述了一种替代方法，该方法在肩胛下肌和小圆肌之间进行，位于由肩胛下肌和小圆肌筋膜形成的筋膜吊带深部，该吊带深于腋神经终末支——小圆肌神经。
2008 年 1 月至 2014 年 6 月，我们采用该入路对 22 例肩胛骨骨折患者进行了固定，对这些患者进行了回顾性识别，并通过美国肩肘外科医师协会（ASES）评估表和 Constant 评分对其进行前瞻性邀请进行临床评估。还评估了术后外展和内收时的外旋（ER）力量。
5 例患者失访。其余所有患者均为男性，平均年龄为 44.5 岁（28-66 岁）。平均随访时间为 34.7 个月（3-72 个月）。17 例患者的平均 ASES 评分为 86.6（41.6-100）；平均 Constant 评分为 89.3（22-100）。唯一对 ASES 评分有显著影响的因素是同侧上肢神经损伤。10 例接受 ER 评估的患者中有 8 例 ER 力量得到改善或与对侧相当；2 例患者的 ER 力量较弱，这 2 例患者均行肩胛骨脊柱缘的手术固定。
在肩胛盂固定中，肩胛下肌间隙入路可能是一种安全的替代方法，尽管 ER 力量的丧失需要进一步评估。
