三种不同入路在肱骨髁间骨折治疗中的应用疗效分析

Comparison of three different approaches in the treatment of intercondylar fracture of humerus

目的研究尺骨鹰嘴截骨入路锁定钢板内固定术、传统肱三头肌舌形瓣入路以及肱三头肌内外侧入路治疗肱骨髁间骨折的应用情况。方法回顾分析2012年3月—2015年9月在东莞市凤岗医院骨二科接受钢板内固定术治疗的102例肱骨髁间骨折患者的病例资料,其中男性58例,女性54例;平均年龄34.7岁。根据手术入路不同分成三组均为34例,A组采用传统肱三头肌舌形瓣入路,B组采用尺骨鹰嘴截骨入路,C组采用肱三头肌内外侧入路,记录三组患者的手术时间、术中出血量、术后引流量和术后并发症。术后3个月依照Mayo肘关节功能评分系统(MEPS)对患者进行评分,计算治疗有效率并比较结果。结果三组患者的手术时间分别为(128.4±24.5)、(86.0±27.5)和(80.3±24.5)min,差异有统计学意义(P<0.05),术后引流量分别为(380.8±31.8)、(350.8±32.4)和(286.9±26.4)m L,差异有统计学意义(P<0.05);三组的并发症发生率差异无统计学意义(P>0.05),治疗有效率分别为61.8%、88.2%和88.2%,差异有统计学意义(F=6.35,P<0.05)。结论经尺骨鹰嘴截骨入路和肱三头肌内外侧入路手术治疗肱骨髁间骨折疗效显著,能较大程度恢复肘关节功能,而且经肱三头肌内外侧入路能有效减少术后引流量。

Objective To study the application of three different approaches in the treatment of intercondylar fracture of humerus. Methods Clinical data of 102 cases of intercondylar fracture of humerus in Dongguan City Fenggang Hospital was retrospectively analyzed. According to the surgical approach,they were divided into three groups,with 34 cases in each group. Group A used the traditional triceps tongue flap approach,group B used olecranon osteotomy approach and group C used medial and lateral triceps approach. The operative parameters and postoperative complications of the three groups were recorded. Three months after operation,the patients were scored according to the Mayo elbow function scoring system. The treatment efficiency was calculated and the results were compared. Results The operation time of the three groups was（ 128. 4 ± 24. 5）,（ 86. 0 ± 27. 5） and（ 80. 3 ±24. 5） min,respectively,and the difference was statistically significant（ P 0. 05）. Postoperative drainage was（ 380. 8 ± 31. 8）,（ 350. 8 ± 32. 4） and（ 286. 9 ± 26. 4） m L,respectively,and there were significant differences among the three groups（ P 0. 05）. The complication rate had no significant difference（ P 0. 05）. The treatment efficiency was 61. 8%,88. 2% and 88. 2%,respectively,and the difference was statistically significant（ F = 6. 35,P 0. 05）. Conclusion The olecranon osteotomy approach and medial and lateral triceps approach for surgical treatment of intercondylar fracture of humerus had significant clinical effect,which can greatly recover the elbow joint function,and the triceps lateral approach can effectively reduce postoperative drainage.