Evaluation of reverse Judet approach in the treatment of scapular body complicated fractures / 国际外科学杂志

ABSTRACT

Objective:To evaluate the clinical effect of surgical treatment of scapular body complicated fractures with reverse Judet operation approach.Methods:A retrospective review was made on 36 patients with scapular body complicated fractures from Jan. 2013 to Jan. 2019. All the fractures were type Ⅳ according to Miller ME classification. There were 29 males and 7 females, at mean age of 46 years(ranged from 20 to 63 years). High energy traffic injury occurred in 13 patients, high fall injury in 8 patients, heavy pound in 3 patients.CT scan and 3D reconstruction were performed before operation, to expose the scapula with reverse Judet approach and do the internal fixation operation with reconstruction plate. Instructed the patients in functional exercises and clinic effects. All patients were followed up after operation. Twenty patients with scapular body complicated fractures from Jan. 2013 to Jan. 2019 treated by classic Judet approach operation were control analysised, compared the operation time, blood less, Incision healing and the shoulder function score after 1 year postoperation.Results:One-stage incision healing were achieved in all 36 patients, no infection and necrosis occurred in the muscle and skin flaps, all patients were followed up for 1 to 6 years(mean 3.8 years). According to Hardegger evaluation standard, 28 cases were excellent, 8 cases were good, the excellent and good rate was 100%. Opteration time and blood loss were less than those in classic Judet group, the differences were significant( P<0.001). Conclusion:For the surgical treatment of complicated fractures, reverse Judet approach that muscle flap and skin flap separated is feasible, the operation is simple, which can obviously shorten the operation time and blood loss, sufficient exposure is good for the reduction and stable fixation of fractures in the operation, early functional exercise can be proformed after operation, reverse Judet approach is a safe and efficient choice for the surgical treatment of scapular body complicated fractures.