【摘要】 目的比较经肱三头肌两侧入路和鹰嘴V形截骨入路治疗肱骨远端C3型骨折的疗效并探讨操作细节。方法回顾分析2010年4月—2016年9月收治的符合选择标准的36例AO/OTA C3型肱骨远端骨折患者临床资料,均采用切开复位内外侧柱锁定板垂直放置内固定治疗。17例(A组)采用肱三头肌两侧入路,肱骨远端内外侧柱和关节面通过提拉牵引肱三头肌和尺骨鹰嘴进行显露;19例(B组)采用尺骨鹰嘴V形截骨入路,肱骨远端内外侧柱和关节面通过鹰嘴截骨和肱三头肌翻转进行显露。两组患者性别、年龄、侧别、受伤至手术时间、致伤原因等一般资料比较差异无统计学意义(P>0.05)。术后复查随访记录患者患肘疼痛情况、力量、活动度和稳定性,根据Mayo肘关节功能评分(MEPS)评价肘关节总体功能。结果 A组手术时间短于B组手术时间,分别为(115.0±10.4)min、(121.0±12.3)min,比较差异无统计学意义(t=–1.580,P=0.123)。两组患者均获1年以上随访,A、B组随访时间比较差异无统计学意义(t=–0.843,P=0.405)。两组各有1例术后发生异位骨化;A组未发生切口感染,B组1例出现切口浅表感染,静脉应用抗生素2周后治愈;两组均无其他手术并发症。术后3个月随访时所有患者肱骨远端均骨性愈合。末次随访时A、B组肘关节屈伸活动范围分别为(102.0±12.6)、(99.5±10.1)°,比较差异无统计学意义(t=–0.681,P=0.501)。A、B组MEPS评分分别为(82.9±7.3)分和(81.3±7.2)分,比较差异无统计学意义(t=0.670,P=0.507);两组评分等级比较差异无统计学意义(Z=–0.442,P=0.659)。结论在C3型肱骨远端骨折手术治疗中,通过肱三头肌两侧入路提拉尺骨鹰嘴可以显露肱骨远端内外侧柱和关节面,复位后行稳固固定,可取得与鹰嘴V形截骨入路治疗相当的疗效。更多还原

【Abstract】 Objective To compare the effectiveness between paratricipital approach and chevron olecranon V osteotomy approach for the treatment of type C3(AO/OTA) distal humeral fractures and investigate the details of operation. Methods Between April 2010 and September 2016, 36 type C3(AO/OTA) distal humeral fractures were treated with open reduction and bicolumnar orthogonal locking plating fixation by paratricipital approach and chevron olecranon V osteotomy approach respectively. The patients were divided into 2 groups by approach, there were 17 cases in paratricipital group(group A) and the bicolumns and distal humeral joint surface were exposed by traction of triceps and olecranon, and the distal humeral joint surface of the 19 cases in chevron olecranon V osteotomy group(group B) were exposed by osteotomy of the olecranon and reversing of triceps. There was no significant difference in gender, age,dominant side, interval between injury and surgery, causes of injury between 2 groups(P>0.05). Patients were followed up,the postoperative range of motion of elbow joint, strength, pain, and stability in 2 groups were documented and compared;the elbow joint function was evaluated according to Mayo elbow performance score(MEPS). Results The operation time of group A [(115.0±10.4) minutes] was less than that of group B [(121.0±12.3) minutes], but there was no significant difference(t=–1.580, P=0.123). All patients in 2 groups got over 1 year follow-up and there was no significant difference of the follow-up time between 2 groups(t=–0.843, P=0.405). There was 1 case of heterotopic ossification in each group;1 case of incision infection in group A and 1 case of incision superficial infection in group B, and were cured after2 weeks of intravenous antibiotics administration. There was no other operative complications in the 2 groups. At3 months after operation, all the distal humerus healed. At last follow-up, the elbow flexion extension range of groups A and B were(102.0±12.6)° and(99.5±10.1)° respectively, showing no significant difference(t=–0.681, P=0.501). The MEPS scores of groups A and B were 82.9±7.3 and 81.3±7.2 respectively, showing no significant difference(t=0.670, P=0.507);and the evaluation grade also showed no significant difference between 2 groups(Z=–0.442, P=0.659). Conclusion By paratricipital approach and proper traction of the olecranon, the distal humeral articular surface can be exposed in the operation of type C3 distal humeral fractures, followed with same stable fixation after reduction, the effectiveness is equal to by chevron olecranon V osteotomy approach.更多还原