经尺骨鹰嘴截骨和肱三头肌两侧入路治疗成人肱骨远端C型骨折的疗效分析

Clinical analysis of the olecranon osteotomy and brachial triceps brachii approach in the treatment of adults with type C distal humeral fracture

目的探讨经尺骨鹰嘴截骨和肱三头肌两侧入路治疗成人肱骨远端C型骨折的方法和疗效。方法回顾性分析2010年1月~2014年12月60例成人肱骨远端C型骨折手术患者,男性39例,女性21例;年龄18~62岁,平均41.6岁。其中采用经后路尺骨鹰嘴截骨入路42例,C1型12例,C2型11例,C3型19例;经肱三头肌两侧入路18例,C1型15例,C2型3例。结果 60例均获得随访,时间6~18个月,平均13.4个月,骨折全部愈合,愈合时间13~25周,平均16.5周,无内固定松动、断裂,无切口感染、皮肤坏死。经尺骨鹰嘴截骨组优12例,良20例,可6例,差4例,优良率76.2%。经肱三头肌两侧入路组优8例,良7例,可3例,优良率83.3%。结论成人肱骨远端C型骨折根据骨折类型,合理选择经尺骨鹰嘴截骨和肱三头肌两侧入路,尽可能小地减少伸肘装置肌性损伤,关节面尽可能解剖复位,双钢板坚强固定,术后早期功能锻炼,能取得较好临床疗效。

Objective To explore the effects of the olecranon osteotomy and brachial triceps brachii approach in the treatment of adult patients with type C distal humeral fracture.Methods Sixty adults with type C distal humeral fracture hospitalized in our hospital from Jan.2010 to Dec.2014 were included in our study,including 39 males and 21 females with an average age of 41.6（18-62） years.42 cases were treated with the posterior olecranon osteotomy approach（12 cases with type C1,11 cases with type C2,19 cases with type C3） and 18 cases were treated with brachial triceps brachii approach（15 cases with type C1,3 cases with type C2）.Results All 60 cases were followed up for 6 to 18 months,with an average of 13.4 months.All the fractures were healed in the following 13 to 25 weeks,with an average of 16.5 weeks.There was neither loosening nor fracture of internal fixation,nor infection of wound,nor necrosis of skin.Postoperative recovery was evaluated as excellent in 12 cases,good in20 cases,fair in 6 cases and poor in 4 cases,with an excellent and good rate of 76.2% totally.Joint function evaluation of the patients treated with brachial triceps brachii approach was considered as excellent in 8 cases,good in 7cases and fair in 3 cases,with an excellent and good rate of 83.3%.Conclusion Selection of operation method for adults with type C distal humeral fracture via olecranon osteotomy approach or brachial triceps brachii approach properly,reducing muscular injury,achieving articular surface anatomical recovery,combined with fixation with double plate and early exercise after operation,can achieve a significant clinical effect.