Department of Orthopaedics, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, 1558 Sanhuan North Road, Wuxing District, Huzhou, Zhejiang, 313000, China.
Int Orthop. 2024 Oct;48(10):2749-2754. doi: 10.1007/s00264-024-06273-7. Epub 2024 Aug 28.
Scapular glenoid fractures, categorized based on the Ideberg classification, are commonly addressed surgically through approaches like the anterior deltoid-pectoral approach, posterior Judet approach, modified Judet approach, or posterior axillary approach. However, these methods present limitations in exposing the superior part of the glenoid. Therefore, we propose an approach for patients with concomitant acromion fractures, involving the anterior lateral flipping of the fractured acromion, allowing direct superior visualization of the superior and posterior superior parts of the glenoid.
Retrospective analysis was conducted on the data of five patients with shoulder fractures combined with scapular Ideberg III fractures between June 2018 and May 2023. All patients were treated using the shoulder approach above the scapular spine. There were four males and one female, aged 23-54 years with an average age of 36.6 years. One case involved the left shoulder, and four cases involved the right shoulder. X-rays and CT were taken before and after surgery to assess the location of the fractures and the healing status. Clinical evaluation included the assessment of efficacy using the Constant-Murley scoring criteria and analysis of surgical complications.
All five patients were followed up for a duration of 14-36 months. All fractures healed completely, with an average healing time of 4.3 months (range: 3-6 months). There were no complications such as suprascapular nerve injury, nonunion, wound infection, or shoulder joint instability observed postoperatively. At the final follow-up, the Constant-Murley shoulder joint function score ranged from 84 to 98 points, with an average of 91.4 points. Three patients achieved an excellent rating in shoulder joint function score, while two patients achieved a good rating.
The shoulder approach above the scapular spine exhibits advantages such as easy exposure and reduction, minimal intraoperative trauma, and clear visualization.
根据 Ideberg 分类，肩胛盂骨折通常通过前三角肌-胸肌入路、后 Judet 入路、改良 Judet 入路或后腋入路等手术方法进行治疗。然而，这些方法在暴露肩胛盂上部时存在局限性。因此，我们提出了一种针对伴有肩峰骨折患者的方法，涉及骨折肩峰的前外侧翻转，可直接观察肩胛盂的上部和后上部。
回顾性分析了 2018 年 6 月至 2023 年 5 月期间 5 例伴有肩胛盂 Ideberg III 型骨折的肩部骨折患者的数据。所有患者均采用肩胛冈上方的肩部入路治疗。其中男 4 例，女 1 例；年龄 23-54 岁，平均年龄 36.6 岁。左侧 1 例，右侧 4 例。术前和术后均行 X 线和 CT 检查，评估骨折部位和愈合情况。临床评估包括使用 Constant-Murley 评分标准评估疗效，并分析手术并发症。
5 例患者均获得随访，随访时间 14-36 个月。所有骨折均完全愈合，平均愈合时间为 4.3 个月（3-6 个月）。术后无肩胛上神经损伤、骨折不愈合、伤口感染或肩关节不稳定等并发症。末次随访时，Constant-Murley 肩关节功能评分为 84-98 分，平均 91.4 分。3 例肩关节功能评分优，2 例良。
肩胛冈上方的肩部入路具有显露和复位方便、术中创伤小、视野清晰等优点。
