Clinical Research On The Prognostic Effect Of Intraoperative Positioning On Scapular Neck And Glenoid Fractures

Objective:By performing intraoperative treatment of patients with scapular neck and glenoid fractures in different positions and comparing and exploring the clinical indices,the advantages of the upper limb supination position were investigated.Methods:A total of 42 patients with scaphoid neck and glenoid fractures treated in chifeng Hospital,between January 2011 and December 2022,were divided into experimental and control groups based on the different surgical positions.The upper limb supination position was the experimental group(group A,n=22 cases)and the upper limb abduction 90° position was the control group(group B,n=20 cases),to assess and analyze the surgical outcomes of the two groups separately.The diagnosis of the patient must be clear before the surgery.Preoperatively,the patient was given anteroposterior and lateral chest X-ray,routine electrocardiogram,biochemical function,coagulation function,and other tests.After surgery,professional rehabilitation guidance was given to both groups until the injury was completely healed.Intraoperative and postoperative follow-up data were recorded separately for both groups of patients,and the data to be recorded were intraoperative bleeding(ml),incision length(cm),intraoperative postural measurement angle(°),operative time(min),total drainage(ml).Postoperative evaluation of shoulder joint function(Hardegger criteria)and shoulder joint assessment criteria(Constant-Murley criteria)were performed.The patients were also observed and recorded the recovery of skin folds between the deltoid muscle and the acromion and scapular gland during shoulder abduction after surgery,whether they had posterior extension strength and whether the amplitude of movement was consistent with that of the healthy side,so as to judge the functional recovery of the shoulder joint and deltoid muscle.Six months after surgery,an evaluation and scoring were carried out,and statistical analysis was used to compare the effectiveness of the two positions in treating glenoid and scapular neck fractures,respectively.Results:1.The results revealed that the results of the upper limb supination position group were significantly better than those of the upper limb abduction 90° position group in terms of operative time(min),intraoperative measurement angle(°),intraoperative bleeding(ml),and total postoperative drainage(ml),with statistically significant differences(P<0.05).2.The postoperative shoulder function evaluation(Hardegger criteria)and shoulder assessment criteria score(Constant-Murley criteria)were employed to assess the shoulder function six months after surgery,and the results demonstrated that the upper limb supination position group was significantly better than the upper limb abduction 90° position group,with statistically significant differences(P <0.05).3.The deltoid function at six months postoperatively was assessed using the indices of recovery of the skin fold between the affected deltoid and the acromion and scapular gonad during postoperative shoulder abduction,the affected shoulder joint had posterior extension strength,and movement amplitude consistent with that of the healthy side,and the findings suggested that the upper limb supination position group was significantly better than upper limb abduction at 90°position group,and there was a statistically significant difference(P<0.05).Conclusions:During the operation,the upper limb was adopted in the supinated position,the surgical field was fully exposed,and the posterior bundle of the deltoid muscle was avoided to be cut,all of which could avoid injury to the suprascapular and rotator scapular vessels,suprascapular nerve,and axillary nerve.As for the intraoperative period,it was found that the angle between the measured posterior border line of the deltoid and the axillary border line of the scapula was increasingly greater,as the posterior bundle of the deltoid would provide decreasing coverage of the scapular neck and glenoid.Both the length of surgery,intraoperative bleeding,and postoperative drainage were significantly reduced,and the postoperative function of the shoulder joint and deltoid muscle recovered well.