Comparative study of surgical treatments of scapula fracture through the muscle space of rotator cuff approach and Judet approach / 中国修复重建外科杂志

ABSTRACT

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.