Mannambeth Rejith, Kirzner Nathan B, Moaveni Ash K
Orthopaedic Fellow, Alfred Hospital, 55 Commercial Rd, Melbourne, 3004, Prahran, VIC, Australia.
Orthopaedic Registrar, Alfred Hospital, 55 Commercial Rd, Melbourne, 3004, Prahran, VIC, Australia.
J Clin Orthop Trauma. 2020 Jul;11(Suppl 4):S626-S630. doi: 10.1016/j.jcot.2020.05.017. Epub 2020 May 18.
Displaced extraarticular fractures of the scapula are uncommon, and rarely require operative fixation. When managed operatively, a posterior Judet approach with detachment of the deltoid muscle from the scapular spine and elevation of the infraspinatus from its fossa, is often performed. This approach is invasive and involves extensive soft tissue dissection. This paper describes the utility of single-column fixation with a direct lateral column approach, with mobilisation of the deltoid, and elevation of the interval between the infraspinatus and teres minor. Our aim is to assess the functional and radiological outcomes of this alternative approach.
We performed a retrospective cohort study of all patients who underwent operative fixation of their extra-articular scapula fracture (with at least 12 months follow up), using the direct lateral-column approach. Operative indications included patients with an extra articular scapular neck or body fracture, with medial/lateral displacement of ≥20 mm, angulation ≥45°, double disruption of the shoulder suspensory complex, and glenopolar angle (GPA) ≤ 22°. Functional outcomes were assessed by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Subjective Shoulder Value (SSV), pain score & return to work. Radiological assessment was done by 2 independent assessors.
Between January 2014 and December 2016, 12 patients (11 males and 1 female) underwent fixation of their scapula fracture using this approach. Eleven patients (91.7%) returned their questionnaire at an average of 15.6 months (12-28 months). All fractures had healed at the time of the final follow-up. The scapular neck angulation was corrected from 38.7° pre-operatively (0-74°) to 3.6° post-operatively (0-20°). The mean post-operative GPA was 35.4° (30.2°-42.0°). None of the patients had superficial or deep infections, or post-operative neurovascular injuries. Two patients underwent elective removal of their clavicle hook plates. The mean SSV was 88.9 (70-100) and mean pain score was 1.5 (0-8). The mean DASH score was 11.4 (0-51.6). Ten patients returned back to their pre-injury work, with an average return to work of 3.3 months (2 weeks-8 months). Only one patient had a poor DASH score. He had associated ipsilateral segmental fracture of the humerus, fracture of the lateral clavicle and brachial plexus injury.
The direct lateral-column approach is an alternative technique for fixation of the extra-articular neck and body scapular fracture. Plating of the lateral column of the scapula through this single approach is associated with correction of scapular angular deformity, no complications and good clinical results at more than 12 months' follow-up.
肩胛骨关节外移位骨折并不常见，很少需要手术固定。手术治疗时，常采用Judet后路，将三角肌从肩胛冈分离，并将冈下肌从其窝中掀起。这种方法具有侵袭性，涉及广泛的软组织解剖。本文描述了采用直接外侧柱入路进行单柱固定的实用性，包括三角肌的活动以及冈下肌和小圆肌间隙的掀起。我们的目的是评估这种替代方法的功能和影像学结果。
我们对所有采用直接外侧柱入路进行肩胛骨关节外骨折手术固定（至少随访12个月）的患者进行了回顾性队列研究。手术指征包括肩胛颈或体部关节外骨折、内/外侧移位≥20mm、成角≥45°、肩悬吊复合体双重断裂以及肩胛极角（GPA）≤22°的患者。通过手臂、肩部和手部功能障碍（DASH）问卷、主观肩部评分（SSV）、疼痛评分及恢复工作情况来评估功能结果。影像学评估由2名独立评估者进行。
2014年1月至2016年12月期间，12例患者（11例男性和1例女性）采用这种方法进行了肩胛骨骨折固定。11例患者（91.7%）平均在15.6个月（12 - 28个月）时返回了问卷。所有骨折在最终随访时均已愈合。肩胛颈成角术前为38.7°（0 - 74°），术后纠正至3.6°（0 - 20°）。术后平均GPA为35.4°（30.2° - 42.0°）。所有患者均未发生浅表或深部感染，也没有术后神经血管损伤。2例患者择期取出了锁骨钩钢板。平均SSV为88.9（70 - 100），平均疼痛评分为1.5（0 - 8）。平均DASH评分为11.4（0 - 51.6）。10例患者恢复了伤前工作，平均恢复工作时间为3.3个月（2周 - 8个月）。只有1例患者DASH评分较差。他伴有同侧肱骨节段性骨折、外侧锁骨骨折和臂丛神经损伤。
直接外侧柱入路是肩胛骨关节外颈和体部骨折固定的一种替代技术。通过这种单一入路对肩胛骨外侧柱进行钢板固定，在超过12个月的随访中，可纠正肩胛角畸形，无并发症，临床效果良好。
