鹰嘴截骨入路治疗肱骨髁间C型骨折疗效分析

Analysis of curative effect by olecranon osteotomy approach in the treatment of humeral intercondylar type C fracture

目的探讨鹰嘴截骨入路治疗肱骨髁间C型骨折的效果。方法 32例肱骨髁间C型骨折患者,其中采用尺骨鹰嘴截骨入路治疗患者18例（尺骨鹰嘴截骨组）,同期采用肱三头肌舌形肌瓣入路治疗患者14例（肱三头肌舌形肌瓣组）。治疗后进行随访记录,根据骨折愈合情况、视觉模拟评分法（VAS）评分、并发症情况、Mayo肘关节功能评分（MEPS）及优良率进行疗效评定。结果尺骨鹰嘴截骨组随诊12--20个月,平均随诊15.4个月;肱三头肌舌形肌瓣组随诊12--22个月,平均随诊16.8个月。两组骨折愈合时间及末次随访VAS评分比较,差异均无统计学意义（P〉0.05）。尺骨鹰嘴截骨组肘关节屈伸活动弧大于肱三头肌舌形肌瓣组,两组比较,差异有统计学意义（P=0.017〈0.05）;尺骨鹰嘴截骨组MEPS评分及优良率均优于肱三头肌舌形肌瓣组,两组比较,差异有统计学意义（P〈0.05）。结论尺骨鹰嘴截骨入路治疗肱骨髁间C型骨折具有操作简单、骨折愈合率高、肘关节功能好、并发症少的优点,有良好的应用前景,可作为肱骨髁间C型骨折的首选手术入路。

Objective To investigate effect by olecranon osteotomy approach in the treatment of humeral intercondylar type C fracture. Methods Among 32 patients with humeral intercondylar type C fracture, 18 cases of them received ulna olecranon osteotomy approach for treatment（ulna olecranon osteotomy group）, and the other 14 cases received triceps brachii muscle liguliform muscle flap approach for treatment（triceps brachii muscle liguliform muscle flap group）. Follow-up and records were made after treatment. Curative effects were evaluated by fracture healing condition, visual analogue scale（VAS） score, complications status, Mayo elbow performance score（MEPS） and good rate. Results The ulna olecranon osteotomy group received follow-up for 12～20 months, with the average as 15.4 months. The triceps brachii muscle liguliform muscle flap group received follow-up for 12～22 months, with the average as 16.8 months. There were no statistically significant differences of fracture healing time and VAS scores in the last follow-up between the two groups（P〈0.05）. The ulna olecranon osteotomy group had larger joint flexion activity radian than the triceps brachii muscle liguliform muscle flap group, and their difference had statistical significance（P=0.0170.05）. The ulna olecranon osteotomy group also had better MEPS score and good rate than the triceps brachii muscle liguliform muscle flap group, and their difference had statistical significance（P〈0.05）. Conclusion Olecranon osteotomy approach in the treatment of humeral intercondylar type C fracture has advantages of easy operation, high fracture healing rate, good elbow joint function, and few complications. This method contains bright prospect as the preferred operational approach in treating humeral intercondylar type C fracture.