尺骨鹰嘴V形截骨与斜行截骨治疗肱骨髁间C型骨折

Comparison effect of chevron and oblique olecranon osteotomy in the treatment of patients with intercondylar fractures of the humerus

目的比较肱骨髁间C型骨折切开复位术中尺骨鹰嘴V形截骨与斜行截骨的疗效。方法对56例肱骨髁间骨折患者行尺骨鹰嘴截骨内固定治疗,其中V形截骨组32例,斜行截骨组24例。比较两组术后肘关节功能恢复情况、骨折愈合时间及术后并发症发生率。结果患者均获得随访,时间6~21个月。V形截骨组与斜行截骨组术后Cassebaum评分优良率分别为23/32和18/24,差异无统计学意义(P>0.05);Mayo功能评分分别为65~100(82.5)分和70~100(84.6)分,差异无统计学意义(P>0.05);骨折愈合时间分别为8~21(11.2)周和6~20(10.4)周,差异无统计学意义(P>0.05);V形截骨组8例、斜行截骨组1例发生创伤性骨关节炎,两组并发症发生率比较差异有统计学意义(P<0.05)。结论肱骨髁间骨折行尺骨鹰嘴斜行截骨入路可充分暴露骨折端,且较V形截骨具有减少创伤性骨关节炎发生的优势,是一种可行的截骨方式。

Objective To compare the functional outcomes of chevron osteotomy and oblique osteotomy in treating intercondylar fractures of the humerus. Methods The 56 patients with intercondylar fractures of the humerus were treated by open reduction and internal fixation using the olecranon osteotomy approach. Among them,32 cases underwent chevron osteotomy and 24 cases accepted oblique osteotomy. Two groups were compared in the postoperative function of the elbow,the healing time and the rate of postoperative complication. Results The follow-up time was6 - 21 months. The excellent and good rate of Cassebaum scores were 23/32 and 18/24 in chevron osteotomy group and oblique osteotomy group,the difference had no statistical significance（ P〈0. 05）. The Mayo elbow performance scores were 65 - 100（ 82. 5） and 70 - 100（ 84. 6） respectively,the difference was not statistically significant（ P〈0. 05）. The union of fracture spend 8 - 21（ 11. 2） weeks and 6 - 20（ 10. 4） weeks respectively,there was not statistical difference（ P〈0. 05）. There were 8 patients had traumatic arthritis in chevron osteotomy group and 1 patient in oblique osteotomy group. The incidence rate difference of complications in the two groups was statistically significant（ P〈0. 05）. Conclusions Oblique osteotomy approach not only expose the surgical field fully,but also is better for the stability of the olecranon,decreasing of traumatic arthritis rate and reducing bone nonunion rate. It is a feasible osteotomy approach.