Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Switzerland.
University of Luzern, Luzern, Switzerland.
Oper Orthop Traumatol. 2023 Dec;35(6):390-396. doi: 10.1007/s00064-023-00819-5. Epub 2023 Aug 18.
Presentation of a minimally invasive surgical approach for the treatment of scapular fractures and the clinical outcome using this technique.
Displaced extra-articular fractures of the scapula body and glenoid neck (AO 14B and 14F) and simple intra-articular fractures of the glenoid.
Complex intra-articular fractures and isolated fractures of the coracoid base.
Make a straight or slightly curved incision along the lateral margin of the scapula leaving the deltoid fascia intact. Identify the interval between the teres minor muscle and infraspinatus to visualize the lateral column, whilst retracting the deltoid to visualize the glenoid neck. Reduce and align the fracture using direct and indirect reduction tools. A second window on the medial border of the scapula can be made to aid reduction and/or to augment stability. Small (2.0-2.7 mm) plates in a 90° configuration on the lateral border and, if required, on the medial border are used. Intra-operative imaging confirms adequate reduction and extra-articular screw placement.
Direct postoperative free functional nonweight-bearing rehabilitation limited to 90° abduction for the first 6 weeks. Sling for comfort. Free range of motion and permissive weight-bearing after 6 weeks.
We collected data from 35 patients treated with minimally invasive plate osteosynthesis (MIPO) between 2011 and 2021. Average age was 53 ± 15.1 years (range 21-71 years); 17 had a type B and 18 a type F fracture according the AO classification. All patients suffered concomitant injuries of which thoracic (n = 33) and upper extremity (n = 25) injuries were most common. Double plating of the lateral border (n = 30) was most commonly performed as described in the surgical technique section. One patient underwent an additional osteosynthesis 3 months after initial surgery due to pain and lack of radiological signs of healing of a fracture extension into the spine of the scapula. In the same patient, the plate on the spine of scapula was later removed due to plate irritation. In 2 patients postoperative images showed a screw protruding into the glenohumeral joint requiring revision surgery. After standardisation of intra-operative imaging following these two cases, intra-articular screw placement did not occur anymore. No patient suffered from iatrogenic nerve injury and none developed a wound infection.
介绍一种治疗肩胛骨折的微创外科手术方法及其临床疗效。
关节外肩胛体部和肩胛颈骨折（AO 14B 和 14F）以及简单的关节内肩胛盂骨折。
复杂的关节内骨折和喙突基底部的孤立骨折。
沿肩胛外侧缘做一平直或略弯的切口，保留三角肌筋膜完整。识别小 圆肌和冈下肌之间的间隙，以显露出外侧柱，同时将三角肌向外侧牵拉，显露出肩胛颈。使用直接和间接复位工具来复位和对齐骨折。在肩胛内侧缘做第二个窗口以辅助复位和/或增加稳定性。在外侧缘使用小（2.0-2.7mm）90°角钢板，如果需要，在内侧缘也使用。术中影像学检查确认复位满意和关节外螺钉放置正确。
直接术后自由非负重功能康复，最初 6 周限制外展 90°。吊带用于舒适。6 周后可进行全范围活动和允许负重。
我们收集了 2011 年至 2021 年期间采用微创钢板接骨术（MIPO）治疗的 35 例患者的数据。平均年龄 53±15.1 岁（范围 21-71 岁）；17 例为 AO 分类的 B 型骨折，18 例为 F 型骨折。所有患者均伴有其他合并伤，其中胸部（n=33）和上肢（n=25）损伤最常见。如手术技术部分所述，最常采用外侧缘双钢板固定（n=30）。1 例患者因初始手术后疼痛且无影像学愈合迹象，骨折延伸至肩胛脊柱，3 个月后再次行骨愈合术。在同一患者中，由于钢板刺激，后来取出了肩胛脊柱上的钢板。2 例患者术后影像学显示螺钉突入盂肱关节，需要进行翻修手术。这两例病例后，我们对术中影像学进行了标准化，此后关节内螺钉放置不再发生。无患者发生医源性神经损伤，也无患者发生伤口感染。
