【摘要】 目的 探讨经腋窝入路内固定治疗IdebergⅡ型肩胛盂骨折对患者肩关节功能的恢复情况及术后并发症发生的影响。方法 选取2022年1月至2024年1月于本院接受治疗的共计124例IdebergⅡ型肩胛盂骨折患者作为研究对象。根据不同术式分为观察组(经腋窝入路内固定,61例)与对照组(肩胛骨外侧缘肌间隙入路内固定,63例)。采用倾向性评分匹配(propensity score matching,PSM)法按1:1匹配后,最终从每组中各筛选出50例患者。采用重复测量方差分析手术前后的盂极角(glenopolar angle,GPA)、肩胛盂前后倾斜角、上下倾斜角及肩关节功能活动度。采用广义估计方程(generalized estimating equation,GEE)比较两组患者在术后不同时间点(3个月、6个月、1年)的Constant-Murley评分与上肢功能障碍(disability of arm,shoulder and hand,DASH)评分指标平均得分差异。比较两组患者术后的并发症情况。结果 观察组手术时间、术中出血量、切口长度、术后切口愈合时间以及住院时间均低于对照组(P<0.05)。两组患者术后GPA与肩关节功能活动度显著增加(P <0.05),肩胛盂前后倾斜角与上下倾斜角均显著下降(P <0.05)。两组患者在术后不同时间点GPA、肩胛盂前后倾斜角、肩胛盂上下倾斜角及肩关节功能活动度(前屈、外展、外旋、内旋、后伸)之间的差异有统计学意义(P<0.05)。在术后不同时间点中,观察组的GPA与肩关节功能活动度高于对照组(P<0.05),肩胛盂前后倾斜角与上下倾斜角低于对照组(P<0.05),表明观察组的GPA、肩胛盂前后倾斜角、肩胛盂上下倾斜角及肩关节功能活动度改善程度优于对照组。两组患者的GPA、肩胛盂前后倾斜角、肩胛盂上下倾斜角及肩关节功能活动度指标在时间效应、组间效应和交互效应之间差异有统计学意义(P<0.001)。GEE模型分析显示,与对照组比较,观察组Constant-Murley评分显著增加(P<0.05),DASH评分显著降低(P<0.05);与术前比较,术后3个月、6个月、1年的Constant-Murley评分显著增加(P<0.05),DASH评分显著降低(P<0.05)。观察组出现1例神经损伤,1例软组织挛缩,未出现切口感染;对照组出现2例切口感染,3例神经损伤,3例软组织挛缩。两组患者术后并发症的总发生率比较差异有统计学意义(P<0.05)。结论 采用经腋窝入路内固定治疗IdebergⅡ型肩胛盂骨折,可改善患者的肩关节功能,提升治疗效果并有助于降低术后并发症的发生率。更多还原

【Abstract】 Objective To investigate the effect of internal fixation via axillary approach on the recovery of shoulder joint function and postoperative complications in patients with Ideberg type Ⅱ glenoid fractures.Methods A total of 124 patients with Ideberg type Ⅱ scapular glenoid fractures who were treated in our hospital from January 2022 to January 2024 were selected as the study subjects.Patients treated with different surgical techniques were divided into an observation group(61 cases) and a control group(63 cases).After 1:1 matching using propensity score matching(PSM) method,50 patients were selected from each group.Repeated measures ANOVA was used to analyze the glenoid polar angle(GPA),scapular anterior posterior tilt angle,up-down tilt angle,and shoulder joint functional range of motion before and after surgery.The generalized estimation equation(GEE) was used to compare the differences in Constant-Murley scores and the average scores of upper limb dysfunction(DASH)scoring indicators between two groups of patients at different postoperative time points(3 months,6 months,1 year).Compare the postoperative complications between two groups of patients.Results The operation time,intraoperative blood loss,incision length,postoperative incision healing time and hospitalization time in the observation group were lower than those in the control group(P <0.05).The GPA and shoulder joint functional range of motion of the two groups increased significantly(P <0.05),and the anteroposterior tilt angle and up and down tilt angle of the scapular glenoid decreased significantly(P <0.05).There were significant differences in GPA,scapular glenoid anteroposterior inclination angle,scapular glenoid up and down angle,and shoulder joint functional range of motion(flexion,abduction,external rotation,internal rotation,and extension) between the two groups at different time points after operation(P <0.05).At different time points after operation,the GPA and shoulder joint functional activity of the observation group were higher than those of the control group(P <0.05),and the anteroposterior inclination angle and up and down angle of scapular glenoid were lower than those of the control group(P <0.05),indicating that the improvement of GPA,scapular glenoid anteroposterior inclination angle,scapular glenoid up and down angle and shoulder joint functional activity of the observation group was better than that of the control group.There were statistically significant differences in GPA,scapular glenoid anteroposterior tilt angle,scapular glenoid up and down tilt angle,and shoulder joint functional activity index between the two groups in time effect,inter-group effect and interaction effect(P <0.001).GEE model analysis showed that compared with the control group,the Constant-Murley score of the observation group was significantly increased(P <0.05),and the DASH score was significantly decreased(P <0.05).The Constant-Murley scores at 3 months,6 months and 1 year after operation were significantly higher than those before operation(P <0.05),and the DASH scores were significantly lower than those before operation(P <0.05).There was 1 case of nerve injury and 1 case of soft tissue contracture in the observation group,and no incision infection occurred.There were 2 cases of incision infection,3 cases of nerve injury,and 3 cases of soft tissue contracture in the control group.There was a significant difference in the total incidence of postoperative complications between the two groups(P <0.05).Conclusions Internal fixation via axillary approach in the treatment of Ideberg type Ⅱ glenoid fractures can improve the shoulder joint function of patients,improve the treatment effect,and it also helps to reduce the incidence of postoperative complications.更多还原