Département d'Orthopédie Traumatologie du CHU de Toulouse, Hopital Pierre Paul Riquet, Toulouse, France.
Clinique Universitaire du Sport, Toulouse, France.
Int Orthop. 2023 Jun;47(6):1557-1564. doi: 10.1007/s00264-023-05754-5. Epub 2023 Mar 15.
Scapular fractures are uncommon and mainly treated nonoperatively. Judet's posterior approach allows access to the fracture site through the infraspinatus fossa and may be a technical option when ORIF is decided. The aims of this study were to determine clinical and radiographic outcomes of patients who underwent scapular body and/or glenoid fractures fixation via Judet's posterior approach.
We conducted a retrospective single-centre study, and all patients admitted for scapular fracture who underwent osteosynthesis via Judet's approach between January 2014 and September 2021 were included. At a minimum follow-up of one year, clinical outcomes were analyzed through subjective shoulder value (SSV) and Constant-Murley score (CMS). Strength in external rotation was measured in adduction and in 90° abduction and compared to healthy side. Radiographic analysis evaluated postoperative fracture reduction on CT scan and glenohumeral osteoarthritis according to Samilson's classification at last follow-up.
Twenty-one patients were included with a mean follow-up of 44.9 months. Mean SSV, CMS, and adjusted CMS were 73.8% ± 21.0, 65.8 points ± 19.5, and 72.8% ± 20.8, respectively. Strength in external rotation in adduction of the affected shoulder showed significant impairment when compared with the contralateral side (respectively 7.79 kg ± 4.29 and 12.0 kg ± 3.84, p = 0.02). All fractures healed uneventfully, but five patients (23.8%) required early revision surgery for intra-articular screws in three. Intra-articular gap measure decreased from 3.75 mm ± 1.93 in preoperative to 0.59 mm ± 0.97 after ORIF. The rate of arthritis was 15% at last follow-up.
Patients who underwent scapular fracture osteosynthesis via Judet's posterior approach exhibited satisfactory but incomplete recovery of the affected shoulder as evidenced by functional scores and external rotation strength measurements at a mean follow-up of 44.9 months. Because of the risk of intra-articular screws, postoperative CT scan is mandatory.
肩胛骨骨折并不常见，主要采用非手术治疗。Judet 后入路可通过肩胛下窝进入骨折部位，当决定切开复位内固定 (ORIF) 时，这可能是一种技术选择。本研究旨在确定通过 Judet 后入路治疗肩胛骨体和/或肩胛盂骨折的患者的临床和影像学结果。
我们进行了一项回顾性单中心研究，纳入了 2014 年 1 月至 2021 年 9 月期间因肩胛骨骨折接受 Judet 入路切开复位内固定的所有患者。在至少 1 年的随访时，通过主观肩部值 (SSV) 和 Constant-Murley 评分 (CMS) 分析临床结果。在外展 90°时，在肩胛骨内收位测量外旋力量，并与健侧进行比较。在最后一次随访时，通过 CT 扫描评估术后骨折复位情况，并根据 Samilson 分类评估肩盂肱关节炎。
共纳入 21 例患者，平均随访 44.9 个月。平均 SSV、CMS 和校正 CMS 分别为 73.8%±21.0、65.8 分±19.5 和 72.8%±20.8。与健侧相比，患侧肩胛骨内收时的外旋力量明显受损（分别为 7.79kg±4.29 和 12.0kg±3.84，p=0.02）。所有骨折均愈合良好，但 5 例（23.8%）因 3 例关节内螺钉需要早期翻修手术。关节内间隙从术前的 3.75mm±1.93 减少到 ORIF 后的 0.59mm±0.97。最后一次随访时关节炎的发生率为 15%。
通过 Judet 后入路治疗肩胛骨骨折的患者在平均 44.9 个月的随访时，功能评分和外旋力量测量显示受影响的肩部有令人满意但不完全的恢复。由于关节内螺钉的风险，术后 CT 扫描是必需的。
