Department of orthopedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China.
Department of orthopedics, National Regional Medical Center, Binhai Campus of the the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
BMC Surg. 2024 Oct 18;24(1):319. doi: 10.1186/s12893-024-02623-9.
Due to its deep position and complex surrounding anatomy, the scapular glenoid fracture was relatively difficult to deal with especially in cases of severe fracture displacement. Improper treatment may lead to failure of internal fixation and poor fracture reduction, severely affecting the function of the shoulder joint. Inferior scapular glenoid fracture was Ideberg type II fracture, and posterior approach was commonly used to deal with inferior scapular glenoid fracture. However, there are shortcomings of above surgical approach for inferior scapular glenoid fracture, such as insufficient exposure of the operative field, significant trauma, and limited screw fixation direction. This study adopts the axillary approach for surgery, which has certain advantages.
The clinical data of 13 patients with Ideberg type II scapular glenoid fractures treated from December 2018 to January 2024 were retrospectively analyzed. There were 8 males and 5 females, with an age range of 19 to 58 years and an average age of 38 years. The causes of injury were falls from heights in 7 cases and car accidents in 6 cases. There were 5 cases on the left side and 8 cases on the right side. The time from injury to surgery was 2 to 11 days, with an average of 5.5 days. All cases underwent open reduction and internal fixation through the axillary approach. Postoperative X-ray and CT three-dimensional reconstruction were performed on the next day to evaluate the fracture reduction and the position of internal fixation. During the follow-up period, follow-up examinations were performed every two months in the first half of the year and every three months in the second half. CT scans were performed during the examinations to assess the glenohumeral joint congruence, fracture healing, and position of internal fixation. The shoulder joint function was evaluated at 6 months postoperatively according to the Constant-Murley value score.
The patients all achieved primary wound healing after surgery, without any complications such as infection or nerve injury. Re-examination on the second day after operation, all fractures obtained excellent reduction, and the internal fixation was in excellent position, and no screw was found to enter the joint cavity. All patients in this group were followed up for 6 to 25 months, with an average follow-up time of 11.7 months. All fractures were bony unioned, and the healing time ranged from 4 to 6 months, with an average healing time of 4.8 months. At 6-month follow-up, according to the Constant-Murley score, 11 cases were excellent and 2 case was good.
Open reduction and internal fixation through the axillary approach is an feasible and safe surgical method for the treatment in scapular Ideberg type II glenoid fractures with less stripping of soft tissue, minimal surgical trauma, and the incision is concealed and beautiful. It can provide a strong internal fixation for fractures, so patients can perform functional exercise early after operation, and the clinical results is satisfactory.
由于肩胛盂的位置深且周围解剖结构复杂，肩胛盂骨折尤其在严重移位时较难处理。处理不当可能导致内固定失败和骨折复位不良，严重影响肩关节功能。肩胛盂下极骨折为 Ideberg Ⅱ型骨折，通常采用后入路处理肩胛盂下极骨折。然而，对于肩胛盂下极骨折，这种手术入路存在一些缺点，如手术野暴露不足、创伤大、螺钉固定方向有限等。本研究采用腋路入路进行手术，具有一定优势。
回顾性分析 2018 年 12 月至 2024 年 1 月采用腋路入路治疗的 13 例 Ideberg Ⅱ型肩胛盂骨折患者的临床资料。男 8 例，女 5 例；年龄 19～58 岁，平均 38 岁。致伤原因：高处坠落伤 7 例，车祸伤 6 例。左侧 5 例，右侧 8 例。受伤至手术时间 2～11 d，平均 5.5 d。所有患者均采用腋路切开复位内固定治疗。术后第 2 天行患侧肩关节正位 X 线及 CT 三维重建，评估骨折复位及内固定位置。随访期间，术后前半年每 2 个月复查 1 次，后半年每 3 个月复查 1 次。复查时行 CT 扫描评估盂肱关节吻合情况、骨折愈合及内固定位置。术后 6 个月采用 Constant-Murley 评分评估肩关节功能。
术后所有患者切口均Ⅰ期愈合，无感染、神经损伤等并发症。术后第 2 天复查，所有骨折均获得良好复位，内固定位置良好，未见螺钉进入关节腔。本组患者均获得随访，随访时间 6～25 个月，平均 11.7 个月。所有骨折均骨性愈合，愈合时间 4～6 个月，平均 4.8 个月。末次随访时，根据 Constant-Murley 评分评定疗效，优 11 例，良 2 例。
腋路切开复位内固定治疗肩胛盂 Ideberg Ⅱ型骨折是一种可行、安全的手术方法，该术式对软组织剥离少、手术创伤小，且切口隐蔽、美观。可为骨折提供坚强内固定，术后患者可早期进行功能锻炼，临床效果满意。
