改良肱三头肌劈开入路在肱骨远端关节内骨折中的应用

Application of Improved Triceps Brachii Split Approach in Intra-articular Fracture of Distal Humerus

目的探讨改良肱三头肌劈开入路在肱骨远端关节内骨折治疗的应用效果。方法肱骨远端关节内骨折41例,均采用改良肱三头肌劈开入路,手术复位固定骨折。结果本组41例均获随访,平均10.5（7-21）个月。骨折愈合时间平均为15.5周。按照Jup iter评分系统评价肘关节功能：优10例,良21例,可8例,差2例;功能优良率为75.6%。2例术后5个月发现骨折延迟愈合,1例术后8个月发现骨不连,其中2例经自体髂骨植骨后骨折愈合,1例发生肘关节严重僵硬放弃治疗。2例出现肘关节骨化性肌炎,但肘关节伸屈活动尚可。在术前无尺神经损伤的患者中,术后有2例早期出现环小指麻木,但手指活动正常,经对症处理术后1-3个月时症状消失;1例于术后3个月时开始出现环小指麻木、手指无力的尺神经损伤表现,术后7个月取出内固定物同时行尺神经前移术,症状基本消失。结论改良肱三头肌劈开入路不损伤尺骨关节软骨面及尺神经,手术创伤小,能满足肘关节早期功能锻炼的要求,是治疗肱骨远端关节内骨折一种较好的手术显露方法。

Objective To explore the clinical effect of improved triceps brachii split approach in treatment of intra-articular fracture of distal humerus.Method 41 cases of the intra-articular fracture of distal humerus were treated by open reduction and internal fixation via improved triceps brachii split approach.Results 41 patients were followed up for 7 to 21 months with an average of 10.5 months.The fracture healing time was 15.5 weeks averagely.According to Jupiter elbow scoring system,the elbow joint function were excellent in 10 cases,good in 21 cases,fair in 8 cases and poor in 2 cases.The fineness rate of elbow function rate was 75.6%.2 cases were found fracture delayed union 5 months after operation and 1 case was nonunion 8 months after operation.Of which 2 cases healed by autologous iliac bone grafting and 1 cases gave up further treatment because of severe elbow stiffness.2 cases emerged myositis ossificans of elbow joint with acceptable elbow flexion and extension activities.In preoperative patients without ulnar nerve injury,2 cases were found surround little finger numbness with normal finger activity in the early stage after operation,and achieved symptoms disappeared by 1 to 3 months symptomatic treatment;1 case appeared manifestation of ulnar nerve injury such as surround little finger numbness and fingers marrowless 3 months after operation,and achieved symptoms disappeared by anterior transposition of the ulnar nerve when internal fixators were taken out 7 months after operation.Conclusion The improved triceps brachii split approach can provide sufficient exposure without injury of articular cartilage and ulnar nerve,and it is an ideal surgical exposure method for treatment of intra-articular fractures of distal humerus with less injury and earlier elbows functional exercise.