外侧指总伸肌劈开入路埋头加压螺钉固定治疗肱骨远端关节面骨折的临床疗效

Outcomes of the distal humeral articular fractures fixed by headless compression screws through lateral extensor digitorum communis splitting approach

目的评价经外侧指总伸肌（EDC）劈开入路以埋头加压螺钉固定治疗肱骨远端关节面骨折的临床疗效。方法回顾性分析自2013年1月至2015年12月采用外侧EDC劈开入路以埋头加压螺钉固定治疗肱骨远端关节面骨折并获得完整随访的患者69例。随访7～42个月。采用Mayo肘关节功能评分（MEPS）及肘关节活动范围对肘关节功能进行评价。以影像学方法评价并发症发生情况。采用SPSS13．0软件对数据进行统计学处理。结果病例中女38例，男31例，左侧42例，右侧27例，年龄（46．2±14．6）（18～63）岁。均为摔倒致伤，平均受伤至手术时间为3．6（0—9）d。Dubberley分型：1A型9例，1B型14例，2A型23例，2B型18例，3A型2例，3B型3例。随访（25．14-6．6）（7～42）个月。末次随访时，6例出现2度异位骨化，屈肘≤100°，需行二次肘关节松解。其余患者术后肘关节功能均能满足日常生活需要，屈肘（127．0±8．1）。（90°-140°），伸肘差（6．8±15．2）。（差40°～过伸10°），屈伸活动范围（120．3±18．5）。（60°～150°），前臂旋前（87．7±6．3）。（60°-90°）、旋后（88．5±2．1）。（80°～90°），旋转活动范围（176．2±6．4）。（150°～180°），MEPS评分为（93．5±6．8）（80～100）分，63例优，6例良。x线评价结果：6例出现2度异位骨化，影响屈伸活动，未见关节退变和缺血性坏死。无关节不稳定、不愈合或内固定失效的表现。没有发生明显疼痛、关节不稳定、感染及神经损伤等并发症。结论采用EDC劈开入路可以较好地显露骨折，通过埋头加压螺钉固定可获得稳定固定，允许术后早期活动以恢复肘关节功能，从而获得良好的疗效。

Objective To evaluate the clinical outcomes of distal humeral articular surface fractures fixed by headless compression screws through the lateral extensor digitorum communis （EDC） splitting ap- proach. Methods Retrospective analysis was conducted on 69 cases with distal humeral articular fractures treated with headless compression screws through lateral EDC-splitting approach from January 2013 to December 2015. All the 69 patients were completely followed-up for 7 -42 months. The function of elbow was evaluated by Mayo elbow performance score（MEPS） and range of motion of elbow. The complications were evaluated by imaging. The data were statistically analyzed by SPSS 13.0. Results There were 38 females and 31 males with age of （46.2±14.6） （18 -63 ） years old. Forty-two were in left and 27 were in right. Fractures were classified according to the Dubberley classification as 9 type-lA, 14 type-lB, 23 type-2A, 18 type-2B, 2 type- 3A, 3 type-3B injuries. The average time from injury to surgery was 3.6 （0 -9） days. The follow-up period was （25.1± 6.6） months. At the last follow-up, heterotopic ossification was found in 6 patients whose elbow flexion were less than 100°and needed a second release surgery. The function of the remaining patients could meet the needs of daily life. The average elbow flexion was 127.0° ＋ 8.1° （90° - 140° ） , while extension was 6.8° -＋ 15.2°（40° - hyperextension 10°）, and the average elbow range of motion was 120.3°±18.5° （60° - 150°）. The forearm pronation was 87.7°±6.3°（60° -90°）, while the average supination was 88.5°-＋2.1°（80° -90°） , and the average rotation was 176.2° ＋-6.4°（ 150° -180°）. The average MEPS score was 93.5±6.8（80-100）. Of them, 63 cases were excellent, and 6 cases were good. X-ray findings： 6 cases had hetero-topic ossification, but without joint degeneration or AVN. All elbows were stable, and without fracture nonunion or hardware failure. Conclusions The distal humeral articular fracture can be better exposed by the EDC-splitting approach, and it can be stably fixed by the headless compression screw. The early functional rehabilitation could be performed and lead to better outcomes.