Porcellini Giuseppe, Palladini Paolo, Congia Stefano, Palmas Alessandro, Merolla Giovanni, Capone Antonio
Policlinico Universitario di Modena, Università degli Studi di Modena e Reggio Emilia, Modena, Italy.
Centro di chirurgia della spalla e del gomito, Ospedale Civile Cervesi, Cattolica, Italy.
J Orthop Traumatol. 2018 Sep 5;19(1):15. doi: 10.1186/s10195-018-0509-8.
Surgical treatment of scapular fractures with posterior approach is frequently associated with postoperative infraspinatus hypotrophy and weakness. The aim of this retrospective study is to compare infraspinatus strength and functional outcomes in patients treated with the classic Judet versus modified Judet approach for scapular fracture.
20 cases with scapular neck and body fracture treated with posterior approach for lateral border plate fixation were reviewed. In 11 of 20 cases, we used the modified Judet approach (MJ group), and in 9 cases we used the classic Judet approach (CJ group). All fractures were classified according to the AO classification system. At follow-up examinations, patients had X-ray assessment with acromiohumeral distance (AHD) measurement, clinical evaluation, active range of motion (ROM) examination, Constant Shoulder Score, and Disability of the Arm, Shoulder and Hand (DASH) Score. Infraspinatus strength assessment was measured using a dynamometer during infraspinatus strength test (IST) and infraspinatus scapular retraction test (ISRT).
Demographic data did not significantly differ between the CJ group and MJ group, except for mean follow-up, which was 4.15 years in the CJ group and 2.33 in the MJ group (p < 0.001). All X-ray examinations showed fracture healing. AHD was significantly decreased in the CJ group (p = 0.006). We did not find significant differences in active ROM between the MJ and CJ groups in the injured arm (p < 0.05). The Constant Score was 75.83 (±14.03) in the CJ group and 82.75 (±10.72) in the MJ group (p = 0.31); DASH Score was 10.16 in the CJ group and 6.25 in the MJ group (p = 0.49). IST showed mean strength of 8.38 kg (±1.75) in the MJ group and 4.61 kg (±1.98) in the CJ group (p = 0.002), ISRT test was 8.7 (±1.64) in the MJ group and 4.95 (±2.1) in the CJ group (p = 0.002). Infraspinatus hypotrophy was detected during inspection in six patients (five in the CJ group and one in the MJ group); it was related to infraspinatus strength weakness in IST and ISRT (p < 0.001).
Infraspinatus-sparing surgical approach for scapular fracture avoids infraspinatus hypotrophy and external-rotation strength weakness. We suggest use of the modified Judet approach for scapular fracture and to restrict the classic Judet approach to only when the surgeon believes that the fracture is not easily reducible with a narrower exposure.
Level IV.
采用后入路手术治疗肩胛骨折常伴有术后冈下肌萎缩和无力。本回顾性研究的目的是比较采用经典Judet入路与改良Judet入路治疗肩胛骨折的患者的冈下肌力量和功能结果。
回顾性分析20例采用后入路外侧钢板固定治疗肩胛颈和肩胛体骨折的病例。20例患者中，11例采用改良Judet入路（MJ组），9例采用经典Judet入路（CJ组）。所有骨折均根据AO分类系统进行分类。在随访检查中，对患者进行X线评估并测量肩峰肱骨头距离（AHD），进行临床评估、主动活动范围（ROM）检查、Constant肩关节评分以及上肢、肩部和手部功能障碍（DASH）评分。在冈下肌力量测试（IST）和冈下肌肩胛回缩测试（ISRT）期间，使用测力计测量冈下肌力量。
CJ组和MJ组的人口统计学数据无显著差异，但平均随访时间除外，CJ组为4.15年，MJ组为2.33年（p<0.001）。所有X线检查均显示骨折愈合。CJ组的AHD显著降低（p=0.006）。我们发现MJ组和CJ组患侧手臂的主动ROM无显著差异（p<0.05）。CJ组的Constant评分为75.83（±14.03），MJ组为82.75（±10.72）（p=0.31）；DASH评分CJ组为10.16，MJ组为6.25（p=0.49）。IST显示MJ组平均力量为8.38kg（±1.75），CJ组为4.61kg（±1.98）（p=0.002），ISRT测试MJ组为8.7（±1.64），CJ组为4.95（±2.1）（p=0.002）。检查时发现6例患者存在冈下肌萎缩（CJ组5例，MJ组1例）；这与IST和ISRT中冈下肌力量减弱有关（p<0.001）。
保留冈下肌的肩胛骨折手术入路可避免冈下肌萎缩和外旋力量减弱。我们建议对肩胛骨折采用改良Judet入路，仅在外科医生认为骨折在较窄暴露下不易复位时才使用经典Judet入路。
四级。
