肘肌瓣入路治疗桡骨头骨折

Effectiveness of anconeus flap approach in the treatment of radial head fractures

目的根据肘肌的解剖特点设计肘肌瓣入路，探讨治疗桡骨头骨折的手术技术。方法选用20侧成人尸体上肢标本，解剖分析肘肌瓣入路的特点及技术，显露桡骨的近端、肱桡关节、桡尺近侧关节。临床治疗桡骨头骨折患者26例，采用肘肌瓣入路复位内固定。结果中副动脉及支配肘肌的桡神经肘肌支在肱三头肌内侧头肘肌延续部自上而下进入肘肌。肘肌远端剥离并向近端掀起不破坏肘肌的血供及神经支配，且能提供桡骨的近端、肱桡关节、桡尺近侧关节的手术显露。26例患者随访12～24个月，平均18．6个月，末次随访采用Mayo肘关节功能评分评估患者肘关节功能，平均92．5分，优良率90．6％。结论采用肘肌瓣入路治疗桡骨头骨折，显露充分，视野清晰，术后恢复佳，且未见肘关节不稳定、屈肌肌力减退、肘肌萎缩等并发症，值得临床推广。

Objective To design anconeus approach based on the anatomical features of anconeus, and explore its application in the surgical treatment of radial head fractures. Methods Twenty adult cadaver upper limb specimens were dissected. The anatomic features and techniques of anconeus flap were studied, and the proximal radius, humeroradial joint and proximal radioulnar joint were exposed. Open reduction and internal fixation of 26 cases of radial head fracture was done via the anconeus flap approach. Results The medial collateral artery and anconeus branch of the radial nerve entered the anconeus along the medial head of triceps and anconens in a proximal to distal direction. Dissecting and lifting the anconeus in a distal to proximal direction provided wide view of radial head and neck, humeromdial joint and proximal radioulnar joint without damaging the blood supply and innervation of the anconeus flap. The 26 patients treated with this approach were follow-up for 12 to 24 months with an average of 18.6 months. At the final follow-up assessment the Mayo elbow performance scoring system was used to evaluate patient＇s elbow function. An average of 92.5 points was reached, with an overall 90.6% satisfactory rate. Conclusion The anconeus flap approach provides good exposure of the surgical field in the treatment of radial head fracture. Postoperative recovery is ideal, without elbow instability, flexor muscle weakness, elbow muscle atrophy and other complications.