尺骨鹰嘴截骨与肱三头肌舌形瓣入路固定治疗肱骨髁间C型骨折

Comparison of the olecranon osteotomy and triceps tongue-shaped flap approach fixation for intercondylar humerus C-type fracture

目的比较不同手术入路(尺骨鹰嘴入路与肱三头肌舌形瓣入路)内固定治疗肱骨髁间C型骨折的临床效果。方法 42例成人肱骨髁间C型骨折患者,20例采用尺骨鹰嘴截骨入路,22例采用肘后肱三头肌形瓣入路,均采用重建钢板内固定。术后行功能锻炼。结果 42例均获随访,时间8～48(29±3.5)个月。根据改良的Cassebaum评分系统评定肘关节功能。尺骨鹰嘴截骨入路组:优14例,良4例,可1例,差1例,优良率90%(18/20);肘后肱三头肌舌形瓣入路组:优15例,良5例,可2例,优良率90.9%(20/22)。两组优良率比较差异无统计学意义(P>0.05)。结论尺骨鹰嘴入路与肱三头肌舌形瓣入路内固定治疗成人肱骨髁间粉碎性骨折配合早期主、被动功能锻炼,多数患者能获得良好的治疗效果。

Objective To study the treatment effect of intercondylar humerus C-type fracture by surgical approaches of olecranon osteotomy and triceps tongue-shaped flap.Methods 42 cases of intercondylar humerus C-type fractures were treated through olecranon approach(20 cases) and triceps approach(22 cases) with Y-shaped plate internal fixation,and all of them were allowed postoperative functional exercise.Results 42 cases were followed up for 8~48(29±3.5) months.According improved Cassebaum Knee Joint Surgery standard,there were 14 cases excellent,4 good,1 fair,and 1 poor,with excellent and good rate of 90%(18/20) with olecranon approach,and 15 excellent,5 good,and 2 fair,with excellent and good rate of 90.9%(20/22) with triceps approach.No statistical difference between the two approaches was found(P>0.05).Conclusions Most of the intercondylar humerus comminute fractures can get good effect by using olecranon osteotomy and triceps tongue-shaped flap approach with Y-shaped plate internal fixation and exercise in the early period.