2.1 normal information Inclusion criteria: Ideberg type I and II scapular fractures involving the scapular glenoid; time from injury to operation < 3 weeks; no severe cardiopulmonary disease and long-term history of taking steroids. Exclusion criteria: those with incomplete follow-up data; those with more underlying diseases who cannot tolerate surgery. A retrospective analysis of 37 cases of scapula fractures diagnosed and treated from 2017-09 to 2019-09, 15 cases were treated with axillary approach (axillary approach group), and 22 cases were treated with pectoralis major deltoid approach (pectoralis major deltoid approach). Muscle approach group), axillary approach group 10 males and 5 females, age (34.2 ± 6.9) years old, disease duration (6.4 ± 1.1) d, preoperative pain VAS score (6.8 ± 0.6) points; triangle of pectoralis major The muscle approach group included 15 males and 7 females, aged (35.8 ± 7.2) years, disease duration (6.1 ± 1.1) days, and VAS score of preoperative pain (6.7 ± 0.7). Comparison of gender (χ2 = 0.009, P = 0.923), age (t = 0.405, P = 0.692), disease duration (t = 0.211, P = 0.835), preoperative pain VAS score (t = 0.107, P = 0.915) between the two groups The difference was not statistically significant (P > 0.05).
This research protocol was conducted following the Declaration of Helsinki and was approved by the Ethics Committee of The People's Hospital of Shangrao City. We reviewed and collected the relevant medical records and follow-up data after obtaining informed consent from the patients.
2.2 Surgical methods Under general anesthesia, the axillary approach group was placed in a lateral decubitus position, with the affected shoulder on top, the shoulder joint was abducted at 90°, the forearm could swing freely, and the forearm and shoulder joint were routinely disinfected and draped. The incision for the axillary approach is made at the posterior border of the axilla, that is, the anterior border of the latissimus dorsi. The incision is 6–8 cm long. The skin, the superficial and deep fascia are incised in sequence, and the axillary lymph nodes and fat are pushed forward along the anterior edge of the latissimus dorsi muscle, and enter between the anterior edge of the latissimus dorsi muscle and the fat in the axilla to expose the upper quadrilateral area, and the upper quadrilateral area is the surgery. Operating window, the upper border is the axillary nerve and the posterior circumflex artery, the lower border is the circumflex scapular artery, the anterior border is the subscapularis vein, the posterior border is the latissimus dorsi tendon and the teres major muscle, and the fracture line of the lateral border of the scapula is exposed; the middle trilateral area is exposed., and mark the superior circumflex scapular artery, anterior thoracic dorsal nerve vessels, posterior latissimus dorsi muscle, and teres major muscle; reveal the lateral border of the scapula and the fracture end; reveal the lateral border of the scapula and the fracture line in the middle trilateral area, and reduce the fracture under direct vision After the block, Kirschner wire was temporarily fixed, and then the anatomical reconstruction plate was used to strengthen the fixation to ensure the smoothness of the articular surface. During the operation, C-arm X-ray machine was used to confirm the anatomical reduction of the fracture, the internal fixation position was good, the drainage tube was routinely placed, and the incision was sutured layer by layer.
The patients in the pectoralis major deltoid approach group were placed in the supine position, a 10–15 cm long incision was made along the deltoid pectoralis major space, the skin, subcutaneous tissue, and superficial fascia were incised in sequence, the cephalic vein was separated and protected, and the cephalic vein was retracted medially. The pectoralis major muscle is retracted laterally, the fascia on the surface of the joint tendon is incised, the subscapularis muscle is exposed, the subscapularis muscle is split along the direction of the muscle fibers, the shoulder joint capsule is exposed, and the joint capsule is cut longitudinally to expose the shoulder Inside the joint, reduction and internal fixation of the fracture are performed under direct vision. After C-arm X-ray fluoroscopy was used to confirm that the fracture end was well reduced and the internal fixation position was correct, the joint capsule was sutured, drainage tubes were routinely placed, and the incision was sutured layer by layer.
2.3 Post-operative treatment Cefuroxime, celecoxib and other drugs were routinely used within 24 hours after operation, passive functional exercise of shoulder joint was started 3 days after operation, and shoulder anteroposterior X-ray and CT film were reviewed to observe the curative effect. The drainage tube was removed 2 or 3 days after the operation according to the drainage situation. The incision was changed regularly and the healing condition was paid attention to, and the sutures were removed 10 to 14 days after the operation. Active functional exercise of the shoulder joint was gradually carried out within 2 weeks after operation. After the X-ray film was reviewed 6 weeks after the operation to confirm the appearance of callus, the active and passive functional exercise of the shoulder joint in all directions was further strengthened, and regular reexamination was performed.
2.4 Observations and Statistical Methods Observation indicators and statistical methods The operation time, intraoperative blood loss, hospital stay, incision length and clinical efficacy at the last follow-up were compared between the two groups . SPSS 22.0 software was used for statistical analysis of data. Measurement data that conformed to normal distribution were expressed as mean ± standard deviation (x ± s) and two independent samples t test was used. The count data were compared by χ2 test, with P < 0.05 as the difference. statistically significant.