Objective: To study the surgical treatments of scapula fracture through the muscle space of rotator cuff approach and the Judet approach, and to evaluate and compare the clinical results.
Methods: Between January 2014 and December 2015, 50 patients with scapula fractures were treated with open reduction and internal fixation of reconstruction plate. Twenty-four patients were treated through the muscle space of rotator cuff approach (group A), and 26 patients were treated through the Judet approach (group B). There was no significant difference in gender, age, cause of injury, type of fracture, and the interval between injury and operation ( P>0.05). The operation time, intraoperative blood loss, and incision length were recorded, and the shoulder functions after fracture healing confirmed by X-ray films were evaluated according to the Hardegger's scoring system.
Results: The operation time, intraoperative blood loss, and incision length in group A were significantly lower than those in group B ( P < 0.05). The incisions of the two groups healed by first intention. All patients were followed up 6-13 months (mean, 11.6 months) in group A and 7-15 months (mean, 12.1 months) in group B. According to Hardegger standard, the effectiveness was rated as excellent in 19 cases, good in 4 cases, and fair in 1 case, with the excellent and good rate of 95.8% in group A, and as excellent in 15 cases, good in 4 cases, fair in 5 cases, and poor in 2 cases with the excellent and good rate of 73.1% in group B. The difference in effectiveness between 2 groups was significant (χ 2=4.81， P=0.03). X-ray films showed that the reduction and internal fixation were satisfied and the fractures healed in 2 groups. The fracture healing time were (29.86±8.38) weeks in group A and (30.05±7.99) weeks in group B, showing no significant difference between 2 groups ( t=0.16, P=0.87).
Conclusion: Compared with the Judet approach, the muscle space of rotator cuff approach has advantages of clearly exposure, less muscular dissection, less intraoperative blood loss, less operation time, easier operation, and satisfied shoulder function can be obtained.
目的: 探讨经肩袖肌间隙入路和 Judet 入路治疗肩胛骨骨折的疗效。.
方法: 2014 年 1 月—2015 年 12 月，采用切开复位、重建钢板内固定治疗 50 例肩胛骨骨折患者。其中 24 例采用经肩袖肌间隙入路（A 组），26 例采用 Judet 入路（B 组）。两组患者性别、年龄、致伤原因、骨折分型、受伤至手术时间等一般资料比较，差异均无统计学意义（ P>0.05）。记录两组手术时间、术中出血量及切口长度，X 线片复查骨折愈合，根据 Hardegger 等评定标准评定疗效。.
结果: A 组手术时间、术中出血量及切口长度均明显小于 B 组（ P<0.05）。两组术后切口均Ⅰ期愈合。两组患者均获随访，A 组随访时间为 6～13 个月，平均 11.6 个月；B 组为 7～15 个月，平均 12.1 个月。末次随访时，根据 Hardegger 等评定标准 A 组获优 19 例、良 4 例、可 1 例，优良率为 95.8%；B 组获优 15 例、良 4 例、可 5 例、差 2 例，优良率为 73.1%；两组疗效比较差异有统计学意义（χ 2=4.81， P=0.03）。X 线片复查示，两组骨折复位及内固定满意，骨折均愈合，A 组愈合时间为（29.86±8.38）周，B 组为（30.05±7.99）周，差异无统计学意义（ t=0.16， P=0.87）。.
结论: 与 Judet 入路相比，经肩袖肌间隙入路治疗肩胛骨骨折，视野显露清晰，肌肉剥离范围小，切口小，出血少，手术时间短，骨折复位内固定操作简便，可获得良好疗效。.
Keywords: Judet approach; Scapula fracture; internal fixation; the muscle space of rotator cuff approach.