Lee Hsin-Hsin, Chuang Hao-Chun, Lin Wei-Chin, Wang Jou-Hua, Hu Ming-Hsien, Lee Pei-Yuan, Su Hong-Lin, Chuang Chang-Han
Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
Department of Orthopaedic Surgery, Show Chwan Memorial Hospital, Changhua 500, Taiwan.
J Clin Med. 2025 Jul 4;14(13):4740. doi: 10.3390/jcm14134740.
Scapular body fractures, when significantly displaced or malunited, can cause glenohumeral discomfort and functional disability. This study compares single- and dual-plating techniques in terms of pain, function, and active range of motion (aROM) in patients with scapular body fractures. Twenty-eight patients with scapular fractures were retrospectively analyzed, with sixteen undergoing single plating treatment and twelve dual plating treatment. The mean age was 44.9 years, and the mean follow-up was 14 months for single plating and 13.8 months for dual plating. Outcomes included Disabilities of the Arm, Shoulder and Hand (DASH) scores, the Visual Analog Scale (VAS) for pain, aROM measurements, and the time to return to work. Functional outcomes were assessed using two-way ANOVA with Šidák's multiple comparisons test at 2 weeks, 4 weeks, 3 months, 6 months, and 1 year. The time to return to work was analyzed with survival analysis and a log-rank test. The single plating group had higher DASH scores than the dual plating group at 2 weeks (44.88 ± 10.81 vs. 32.75 ± 6.05, = 0.005), 4 weeks (28.50 ± 5.91 vs. 22.83 ± 4.24, = 0.033), and 3 months (19.63 ± 2.45 vs. 16.00 ± 2.45, = 0.004), indicating greater disability. VAS scores were also higher in the single plating group at 2 weeks (4.00 ± 1.21 vs. 2.33 ± 0.88, = 0.002) and 4 weeks (2.50 ± 1.03 vs. 1.17 ± 0.94, = 0.008), suggesting faster pain relief in the dual plating group. However, differences were no longer significant after 3 months. At 1 year, the dual plating group demonstrated better external rotation (73 ± 3° vs. 63 ± 5°, = 0.032), with no significant differences in internal rotation, abduction, or forward flexion. Dual plating patients returned to work earlier (Hazard Ratio = 3.346, 95% CI: 1.208 to 9.269, = 0.020). In the current cohort, dual plating for scapular fractures offers superior early pain relief and functional outcomes compared to single plating, along with better external rotation at 1 year and an earlier return to work. These findings suggest that dual plating may facilitate faster recovery and enhanced active range of motion in selected patients, a hypothesis that warrants further investigation through future randomized trials.
肩胛体骨折若发生明显移位或畸形愈合，可导致盂肱关节不适和功能障碍。本研究比较了单钢板和双钢板技术在肩胛体骨折患者的疼痛、功能及主动活动范围（aROM）方面的差异。对28例肩胛骨折患者进行回顾性分析，其中16例行单钢板治疗，12例行双钢板治疗。平均年龄为44.9岁，单钢板治疗的平均随访时间为14个月，双钢板治疗为13.8个月。结果指标包括上肢、肩部和手部功能障碍（DASH）评分、疼痛视觉模拟量表（VAS）、aROM测量值以及重返工作岗位的时间。采用双向方差分析及Šidák多重比较检验在2周、4周、3个月、6个月和1年时评估功能结局。采用生存分析和对数秩检验分析重返工作岗位的时间。单钢板组在2周（44.88±10.81对32.75±6.05，P = 0.005）、4周（28.50±5.91对22.83±4.24，P = 0.033）和3个月（19.63±2.45对16.00±2.45，P = 0.004）时的DASH评分高于双钢板组，表明残疾程度更高。单钢板组在2周（4.00±1.21对2.33±0.88，P = 0.002）和4周（2.50±1.03对1.17±0.94，P = 0.008）时的VAS评分也更高，提示双钢板组疼痛缓解更快。然而，3个月后差异不再显著。在1年时，双钢板组的外旋功能更好（73±3°对63±5°，P = 0.032），在内旋、外展或前屈方面无显著差异。双钢板治疗的患者更早重返工作岗位（风险比=3.346，95%置信区间：1.208至9.269，P = 0.020）。在当前队列中，与单钢板相比，肩胛骨折双钢板治疗在早期疼痛缓解和功能结局方面更优，在1年时外旋功能更好且更早重返工作岗位。这些发现表明，双钢板可能有助于特定患者更快恢复并扩大主动活动范围，这一假设值得通过未来的随机试验进一步研究。
