尺骨鹰嘴截骨入路治疗肱骨远端冠状面骨折的疗效观察

Treatment of coronal shear fracture of the distal end of the humerus by the olecranon osteotomy approach

目的:探讨尺骨鹰嘴截骨入路切开复位内固定治疗肱骨远端冠状面骨折的疗效。方法:回顾性分析2005年1月至2013年1月,采用尺骨鹰嘴截骨入路切开复位内固定治疗的34例肱骨远端冠状面骨折患者的临床资料。男15例,女19例;年龄17~84岁,平均(54.9±10.2)岁;左侧18例,右侧16例。按Bryan-Morrey分型联合McKee分型,Ⅰ型10例,Ⅱ型5例,Ⅲ型10例,Ⅳ型9例。采用Mayo肘关节功能评分对结果进行评价并行统计学分析。结果:随访15~96个月,平均(35.1±7.2)个月。肘关节平均屈(132.1±11.2)°,伸(4.6±1.9)°;Mayo评分73~94分,平均85.9±6.3,优13例,良15例,可6例。Bryan-MorreyⅠ、Ⅱ、Ⅲ和Ⅳ型患者Mayo肘关节功能评分平均为88.6±3.7、85.8±4.6、81.8±5.8和87.5±9.1,差异均无统计学意义。结论:尺骨鹰嘴截骨入路切开复位内固定治疗肱骨远端冠状面骨折的疗效满意,该截骨方法可以维持术后骨折复位,提高肘关节功能。

Objective：To explore the effectiveness of olecranon osteotomy approach for the treatment of coronal shear fracture of the distal end of the humerus. Methods： A retrospective analysis was made on the clinical data of 34 patients with the coronal shear fracture of the distal end of the humerus treated by the olecranon osteotomy approach from January 2005 to January 2013. Of 34 cases,there were 15 boys and 19 girls,aged from 17 years to 84 years （mean,54.9±10.2 years） ; 18 patients had fractures on the left and 16 patients had fractures on the right. Fractures were classified according to the Bryan and Morrey classification united Mckee classification ：type Ⅰ injuries occurred in 10 cases, type Ⅱ injuries in 5 cases, type Ⅲ injuries in 10 cases and type IV injuries in 9 cases. The Mayo elbow functional scores were evaluated for analysis. Results：All the patients were followed up, and the duration ranged from 15 to 96 months, with a mean of （35.1 ±7.2） months. Average arc of motion was （ 132.1 ± 11.2） ° in flexion and （4.6± 1.9） ° in extension. The average Mayo score was 85.9±6.3 （73 to 94 scores）. Thirteen patients got an excellent result, 15 good and 6 poor. The average Mayo score was 85.6±3.7 in type I injuries, 85.8±4.6 in type Ⅱ injuries, 81.8±5.8 in type Ⅲ injuries and 87.5±9.1 in type IV injuries. There were no significant differences in outcomes. Conclusion ：The treatment for the coronal shear fracture of the distal end of the humerus by the olecranon osteotomy approach can achieve the satisfactory curative effect, maintain the reduction and improve the elbow function.