肘后劈开肱三头肌入路治疗肱骨髁间粉碎性骨折

目的探讨肘后劈开肱三头肌入路治疗肱骨髁间粉碎性骨折的疗效及其术后对肘关节功能的影响。方法2006年7月-2011年6月兴国县人民医院采用肘后劈开肱三头肌入路治疗肱骨髁间粉碎性骨折28例，按照AO/ASIF分类：C1 3例，C2 9例，C3 16例，所有患者经后路正中劈开三角肌入路，同时使用钢板或拉力螺钉固定，术后早期行肘关节功能锻炼。结果28例患者中26例获得随访，随访时间6～48个月，平均（24±4）个月，1例骨折端骨质吸收、内固定松动后行肘关节融合固定。3例浅表感染，经换药后治愈。1例深部感染，在治疗过程中开放冲洗未获得愈合，待骨折愈合后拆除内固定时进一步清创后愈合，未再渗液。4例尺神经牵拉损伤，经神经营养药物治疗后恢复。根Cassebaum法评分，优6例，良11例，可6例，差3例，优良率654％。结论肘后劈开肱三头肌入路治疗肱骨髁间粉碎性骨折，可以充分显露术野，有利于手术操作、使骨折更易于达到解剖复位，固定稳定，为肘关节早期锻炼提供了条件，但仍有较高的并发症发生率。

Objective To study the effects of splitting triceps brachii with posterior elbow approach used to treat the humeral intercondylar bursting fractures and to analyze the causes of the disfunction in elbow. Methods From July 2007 to June 2012,28 cases of humeral intercondylar bursting fractures were reviewed.Left elbow： 17 cases; right elbow： 11 cases. According to AO/ASIF classification,type C 1：3,type C 2： 9,and type C 3：16,Posterior operating approach of elbow：split triceps brachii and internal fixation by standard method of plates or lag screws were performed in all cases.The patients began the active training of elbow joint as soon as possible postoperatively. Results 26 cases were followed up for 6-48 months and the average time was （24±4） months. 1 case complicated bone resorption,and the internal fixation loosened,cured after elbow arthrodesis.3 cases complicated superficial infection and recovered after 4 weeks of dressing. 1 case Complicated deep infection,treated With continuous irrigation and drainage and no healing, further debridement did when fractures healing and removed the internal fixation and no effusion.4 cases complicated ulnar nerve injury,which recovered with neural nutrients. According to the Cassebaum scoring system,the effects were evaluated as excellent in 6 cases,good in 11 cases, fair in 6 csaes,and bad in 3 cases, the excellent good rate was 65.4%.Conclusion The application of splitting triceps brachii with posterior elbow approach to be a good method to treat humeral intercondylar bursting fractures,the operative field can attain excellent exposure and be good for operation,the fractures are ease to get anatomical reduction,stable fixation, provided the conditions for the early exercise of elbow joint.But there is still a high incidence rate of complication.