Y形钢板和双钢板经不同置入途径治疗肱骨髁间骨折的比较

Y-shaped plate versus double plate internal fixation via different inserted ways for treatment of humeral intercondylar fractures

背景:成人肱骨裸间骨折内固定及置入途径选择对置入成功及内固定后功能有明显影响。目的:比较Y形钢板和双钢板经不同置入途径治疗肱骨髁间骨折疗效的差异。方法:纳入肱骨髁间骨折患者139例,采用Y形钢板和双钢板两种内固定方式,根据内固定方案分为4组,经尺骨鹰嘴截骨入路44例,经肱三头肌两侧入路46例,经肱三头肌舌状瓣入路27例,经肱三头肌劈开入路22例。随访3个月～2年,根据Aitken和Rorabeck肘关节功能评定标准对各组患者内固定后肘关节功能进行评定。结果与结论:双钢板在尺骨鹰嘴截骨组、肱三头肌两侧组和肱三头肌劈开组中优良率优于Y形钢板(P<0.05),而在肱三头肌舌状瓣组中优良率差异无显著性意义(P>0.05)。前3种入路的双钢板固定优良率差异无显著性意义(P>0.05),但均比肱三头肌舌状瓣入路双钢板固定优良率高(P<0.05)。提示肱骨髁间骨折双钢板固定治疗优于Y形钢板固定,尺骨鹰嘴截骨入路、肱三头肌两侧入路和肱三头肌劈开入路可获得相同的临床效果,而且它们的内固定效果均优于肱三头肌舌状瓣入路。

BACKGROUND：Selection of internal fixation and inserted approach is important to the successful treatment of adult humeral intercondylar fractures.OBJECTIVE：To review the clinical outcome of Y-shaped plate internal fixation and double plate internal fixation for humeral intercondylar fractures through different operative approaches.METHODS：Open reduction and internal fixation using plate were performed in 139 cases with humeral intercondylar fracture,of which triceps splitting was carried out in 22,bilateral triceps was carried out in 46,triceps V shaped severance was carried out in 27,and olecranon osteotomy in 44.All patients were followed up for 3-48 months,and the results were scaled according to Aitken and Rorabeck Elbow Score standard.RESULTS AND CONCLUSION：The excellent and satisfactory rate of two internal fixation methods showed statistical difference（P 0.05） by olecranon osteotomy approach,bilateral triceps approach,and triceps splitting approach;while no statistical difference（P 0.05） by triceps V shaped severance approach.But the excellent and satisfactory rate of the senior three operative approaches in double plate internal fixation compared with triceps V shaped severance approach showed statistical difference（P 0.05）,while no statistical difference（P 0.05）in comparison with each other.The clinical outcome of humeral intercondylar fractures treated with double plate internal fixation was superior to those treated with Y-shaped plate internal fixation.Meanwhile,triceps splitting approach,olecranon osteotomy approach and bilateral triceps approach can obtain the same clinical outcome for humeral intracondylar fractures,and the clinical outcomes of all three operative approaches are superior to those of triceps V shaped severance approach.