经肱三头肌两侧入路治疗肱骨髁间骨折

Evaluation of the bilateral approach through triceps brachii for the treatment of intercondylar fractures of the humerus

目的 介绍经肱三头肌两侧治疗肱骨髁间骨折新的手术入路，并探讨该手术入路不损伤伸肘装置的可能性。方法 采用新鲜成人尸体标本，将肱三头肌从肱骨远端骨面剥离后，分别在屈肘 15°、 30°、 45°、 60°及 80°时，提起肱三头肌，并向内侧或外侧牵拉，记录肌肉提起的高度，观察该入路对肱骨远端、尤其是滑车的显露情况，指导手术的顺利完成，并结合临床治疗加以分析。结果 通过尸体解剖及临床应用发现，肘关节屈曲 45°～ 60°时，可进行髁间骨折的复位固定；肘关节屈曲 15°～ 30°时，可处理髁上骨折部分；肘关节屈曲 80°时，可进一步检查滑车的复位情况。结论 此手术入路适用于 RiseboroughⅡ、Ⅲ型肱骨髁间骨折治疗，在完整保留伸肘装置的情况下，不仅能满足髁间骨折的复位固定，还可使术者从容地处理髁上骨折，并在临床上取得了满意的疗效，是一种值得推广的手术入路。

Objective To introduce a new bilateral triceps brachii approach for the treatment of intercondylar fractures of the humerus, and explore the possibility for the operation without injuring the mechanism of extension of the elbow. Methods With fresh cadaver specimens, the triceps brachii was stripped off from the distal end of the humerus, the muscle belly was elevated and retracted bilaterally, then the height was recorded, and the exposure of the distal humerus was observed, especially to the trochlear region when the elbow were flexed at 15° , 30° , 45° , 60° , 80° respectively. Results Through the cadaver specimen observation and the clinical application, the reduction and fixation of the intercondylar fractures of humerus should be performed when the elbow is flexed at 45°－ 60°， at 15°－ 30° flexion, fracture over the supracondylar can be treated and finally at 80° flexion, the reduction of the trochlear region can be examined. Conclusion This bilateral approach through the triceps brachii is suitable for the treatment both of the intercondylar and epicondylar fractures.