Selection Of Operative Methods For Scapular Complex Injury And Analysis Of Clinical Efficacy

Aim: This is a retrospective comparative study,this study analyzed the clinical effects of different scapular treatment methods on patients with Superior Shoulder Suspensory Complex(SSSC).Methods: From July 2013 to December 2017,38 patients with SSSC injuries admitted to trauma surgery of Weihaiwei People’s Hospital were studied,including 18 males and 20 females,mean age was(45.89±8.11)years,height was(170.48±5.09)cm,weight was(56.34±5.33)Kg,modified Miller classification for scapular complex fractures,10 IB type and 8 II type,10 cases of type III A and 10 cases of type III B.According to the purpose of this study and the operative methods of scapular internal fixation and non-internal fixation in patients with scapular complex injury,38 patients with clavicular fracture and scapular fracture in SSSC were randomly divided into two groups according to the digital table method: Double fixation group,including 20 patients;Single fixation group,including 18 patients.The age,height,weight,time from injury to operation,total blood loss,drainage volume,Hb content,hematocrit(HCT),blood transfusion rate,visual analogue scale(VAS),wound healing and complications were recorded.Herscovici criteria and Constant-Murley scoring system were used to evaluate the results.The evaluation criteria of shoulder joint function were used to evaluate the clinical efficacy and postoperative complications(nonunion of fracture,malunion,delayed union,loosening and breaking of plate and screw,etc.)..Result:(1)There were no significant differences in sex ratio,age,height,weight and BMI between the two groups(P>0.05);(2)There was no significant difference in the cause of injury and Miller classification between the two groups(P>0.05);(3)The operation time in the double fixation group was longer than that in the single fixation group(P<0.05),and the anesthesia time in the double fixation group was longer than that in the single fixation group(P<0.05).The number of fluoroscopy in operation was significantly higher than that in the conservative treatment group(P<0.05),and the length of incision in the double fixation group was significantly higher than that in the conservative treatment group(P< 0.05);(4)There was no significant difference in preoperative hemoglobin between the two groups(P>0.05);the hemoglobin content in the double fixation group was significantly lower than that in the conservative treatment group on the 1st,3rd and 7th day after operation(P<0.05);(5)There was no significant difference in preoperative hematocrit between the two groups(P>0.05).The hematocrit in the double fixation group was significantly lower than that in the conservative treatment group on the 1st,3rd and 7th day after operation(P<0.05);(6)In the comparison of total blood loss,transfusion rate and total drainage volume,the double fixation group was significantly higher than the single fixation group(P<0.05);(7)There was no significant difference in preoperative VAS score between the two groups(P>0.05);the VAS score of1 st,3rd and 7th day after operation was significantly lower in the prescribed treatment group than in the conservative treatment group(P<0.05);(8)Among Herscovici criteria,Constant-Murley scoring system and ROWE scoring system,the shoulder joint excellence rate in the double fixation group was significantly higher than that in the single fixation group(P<0.05);(9)The incidence of skin infection in the double fixation group was significantly higher than that in the conservative treatment group(P<0.05).The incidence of vascular injury in the double fixation group was significantly higher than that in the conservative treatment group(P<0.05).The incidence of brachial plexus injury in the double fixation group was significantly higher than that in the conservative treatment group(P < 0.05).The incidence of delayed fracture healing in the double fixation group was significantly lower than that in the single fixation group(P<0.05).The incidence of delayed fracture healing in the double fixation group was significantly lower than that in the single fixation group(P<0.05).Conclusion:(1)Double fixation of clavicle fracture and scapular fracture can avoid severe shortening of scapular band,abduction fatigue and decrease the mobility of shoulder joint.(2)Shoulder joint functional exercise can be performed early after double fixation of fracture,which can reduce the incidence of malunion and delayed union of scapular fracture,reduce the incidence of shoulder joint dysfunction and long-term shoulder joint functional discomfort.(3)The double fixation method is more traumatic to patients,so for patients with more basic diseases,elderly patients with poor physical fitness can use single fixation treatment.