Mohd Asihin Muhammad Azrin, Bajuri Mohd Yazid, Ganaisan Premganesh K, Ahmad Abdul Rauf
Department of Orthopaedics, Hospital Tuanku Ja'afar, Seremban, Malaysia.
Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Hospital Canselor Tuanku Mukhriz, Kuala Lumpur, Malaysia.
Front Surg. 2019 Dec 17;6:71. doi: 10.3389/fsurg.2019.00071. eCollection 2019.
The study aims to evaluate the short-term functional outcome of open reduction and internal fixation of extraarticular scapular neck and body fractures treated at our center over a period of 2-year duration at a tertiary referral center. Between October 2015 and October 2017, we operated on 20 extraarticular scapular neck and body fracture. Ten were available for a one-off assessment. The mean time to surgery was 10 days (range, 3-19 days) and one-off assessment was done within 6-24 months (mean, 13 months). Indications includes (1) medial/lateral displacement (M/L) ≥ 20 mm, (2) M/L ≥ 15 mm if angular deformity ≥ 30°, (3) Angular deformity ≥ 45°, (4) Double lesion of superior shoulder suspensory complex (SSSC), with displacement ≥10 mm in both lesion, (5) Glenopolar angle (GPA) ≤ 22°, and (6) open scapular fracture. The functional outcome was measured using range motion and strength. Patient-reported outcome was assessed using Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and Short-Form-36 (SF-36) version 1. All patients achieved radiological union at time of assessment. None of the patients had post-operative complications. The mean DASH score was 19.3 (range, 1.7-39.3). All subcategories of SF-36 questionnaire scores between 70 and 89.6, with exception to REE (role limitations due to emotional problems) and REP (role limitations due to physical health). The average range of motion for the injured shoulders; forward flexion 157°, abduction 114°, and external rotation 42°. The strength of operated and non-operated shoulders, respectively, 6.5 and 8.1 kgF of forward flexion, 5.5 and 7.2 kgF of abduction, and 4.1 and 6.3 kgF of external rotation. Open reduction and internal fixation of surgically indicated scapular neck and body fracture is feasible with predictably good functional outcome. The reduced external rotation ROM and strength may be due to the use of Classic Judet approach, however we do not enough data to support this.
本研究旨在评估在一家三级转诊中心，我们中心在2年时间内对关节外肩胛颈和肩胛体骨折进行切开复位内固定术的短期功能结果。2015年10月至2017年10月期间，我们对20例关节外肩胛颈和肩胛体骨折患者进行了手术。其中10例患者可进行一次性评估。手术的平均时间为10天（范围3 - 19天），一次性评估在6 - 24个月内完成（平均13个月）。手术指征包括：（1）内外侧移位（M/L）≥20 mm；（2）若成角畸形≥30°，则M/L≥15 mm；（3）成角畸形≥45°；（4）肩上部悬吊复合体（SSSC）双损伤，两处损伤移位均≥10 mm；（5）肩胛极角（GPA）≤22°；（6）开放性肩胛骨折。使用活动范围和力量来衡量功能结果。采用手臂、肩部和手部功能障碍（DASH）问卷和简短健康调查问卷（SF - 36）第1版评估患者报告的结果。所有患者在评估时均实现了影像学愈合。所有患者均无术后并发症。DASH评分的平均值为19.3（范围1.7 - 39.3）。SF - 36问卷所有子类别得分在70至89.6之间，但情绪问题导致的角色限制（REE）和身体健康问题导致的角色限制（REP）除外。受伤肩部的平均活动范围为：前屈157°、外展114°、外旋42°。手术侧和非手术侧肩部的力量分别为：前屈6.5和8.1 kgF、外展5.5和7.2 kgF、外旋4.1和6.3 kgF。对于手术指征明确的肩胛颈和肩胛体骨折，切开复位内固定术是可行的，功能结果可预测良好。外旋活动范围和力量的降低可能归因于经典Judet入路的使用，然而我们没有足够的数据支持这一点。
