尺骨鹰嘴截骨与肱三头肌两侧入路内固定治疗肱骨髁间骨折的疗效比较

The clinical efficacy of olecranon osteotomy approach and bilateral approach through triceps brachii for the treatment of intercondylar humeral fractures

目的比较尺骨鹰嘴截骨与肱三头肌两侧入路内固定治疗肱骨髁间骨折的疗效。方法对1980年1月至2008年3月国内外发表的尺骨鹰嘴截骨与肱三头肌两侧入路内固定治疗肱骨髁间骨折的文献进行检索。采用Coehrane协作网提供的系统评价方法对纳入文献进行数据抽取、汇总及系统评价。结果共检索到364篇原始文献，经筛选及评价，最后收集到已发表的33篇文献符合纳入标准。随访资料完整的患者876例，其中尺骨鹰嘴截骨入路509例，肱三头肌两侧入路367例。分析显示：肱骨髁间骨折C2及C3型患者尺骨鹰嘴截骨人路内固定的术后肘关节功能评分的优良率（82．32％与79．38％）均高于肱三头肌两侧入路术后肘关节功能评分的优良率（70．59％与64．71％）；C1型患者两种入路的术后肘关节功能评分的优良率差异无统计学意义。14篇文献报道了术后并发症。尺骨鹰嘴截骨入路术后并发症的发生率为4．72％（95％可信区间4．70％-4．74％），肱三头肌两侧入路为8．17％（95％可信区间8．13％-8．21％）。结论尺骨鹰嘴截骨较肱三头肌两侧入路内固定治疗肱骨髁间骨折的疗效佳。

Objeetive Systematically evaluate the clinical efficacy and complications of olecranon osteotomy and bilateral approach through triceps brachii for the treatment of intercondylar humeral fractures. Methods To search the domestic and foreign literatures published from January 1980 to March 2008 about the treatment of intercondylar humeral fractures, which use olecranon osteotomy approach and bilateral approach through triceps brachii. Systematically evaluate these literatures using the methods of systematic review provided by the Cochrane collaboration. Results After the screening and evaluation to the literatures, 33 published literatures that met the inclusive criteria of this study were collected. There were a total of 876 cases of patients whose follow-up data was integrity （olecranon osteotomy approach group for 509 cases;bilat- eral approach through triceps brachii group for 367 cases） and these cases had provided the postoperative scores of elbow joint function. The excellent and good rates of postoperative score of elbow joint function for the type C2 and C3 fracture patients in the olecranon osteotomy approach group were 82.32% and 79.38% respectively; while those in the bilateral approach through triceps brachii group were 70.59% and 64.71% respectively. The former was significantly higher than the latter. The excellent and good rate of the type C1 fracture patients between two approaches groups showed no statistical significant. Fourteen literatures provided the data about postoperative complications, the incidence of complications of patients that received olecranon osteotomy approach was 4.72% （95%CI 4.70%-4.74% ）, and the results also showed that compared with bilateral approach through triceps brachii （8.17%, 95%CI 8.13%-8.21%）. Conclusion To treat intercondylar humeral fractures, postoperative efficacy of olecranon osteotomy approach is better than that of the bilateral approach through triceps brachii. Using olecranon osteotomy approach can get adequate exposure, easy open reduction and internal fixation, quick recover and less complication.