Schildhauer入路治疗肱骨远端C型骨折效果观察

Clinical Effect of Schildhauer Approach in Patients with Type C Fracture of the Distal Humerus

目的探讨Schildhauer入路对肱骨远端C型骨折患者的临床疗效,为改善患者肘关节功能恢复及生活质量提供理论依据。方法选取2013年11月—2016年11月收治的肱骨远端C型骨折患者75例,依据术式不同分组,研究组38例采取Schildhauer入路切开复位内固定,对照组37例采取鹰嘴截骨入路切开复位内固定,比较两组手术情况、骨性愈合时间、术后并发症发生情况及术后6个月肘关节活动情况、伸肘肌力缺损值、手术优良率,并对比两组术前、术后6个月肘关节功能指数评分(Mayo)、臂-肩-手功能障碍评分(DASH)及生活质量评分(SF-36)。计量资料比较采用t检验,计数资料比较采用χ2检验,P<0.05为差异有统计学意义。结果两组术中出血量、手术用时、住院时间比较,差异无统计学意义(均P>0.05),研究组骨性愈合时间短于对照组,差异有统计学意义(P<0.05);术后6个月与对照组比较,研究组肘关节外旋、内旋及屈伸活动度均增加,伸肘肌力缺损值降低,差异有统计学意义(均P<0.05);研究组总优良率(89.47%)与对照组(75.68%)比较,差异无统计学意义(P>0.05);术后6个月与对照组比较,研究组Mayo、SF-36评分升高,DASH评分降低,差异有统计学意义(均P<0.05);研究组术后并发症发生率(5.26%)低于对照组(24.32%),差异有统计学意义(P<0.05)。结论肱骨远端C型骨折患者采用Schildhauer入路切开复位内固定疗效肯定,可明显促进骨折愈合,提高患者肘关节活动度,加速其肘关节功能恢复,改善其生活质量,减少并发症的发生。

Objective To investigate the clinical effect of Schildhauer approach on C type fracture of distal humerus and life quality of patients and to provide a theoretical basis for improving the recovery of elbow joint function.Methods A total of 75 cases of type C fracture of the distal humerus from November 2013 to November 2016 were selected.They were grouped according to different operation methods.Thirty-eight cases in the study group were treated with the open reduction and internal fixation with Schildhauer approach,and thirty-seven cases in the control group were treated with the open reduction and internal fixation with olecranon osteotomy approach.The operative condition,bone healing time,postoperative complications,activity of elbow joint,elbow muscle strength defect and operation excellence rate after 6 months of the operationin two groups were compared.The elbow function index score（Mayo）,arm-shoulder-hand dysfunction score（DASH）and quality of life score（SF-36）were compared between the two groups before and 6 months after the operation.Measurement data were compared by t test and enumeration data were compared by χ^2 test.P〈0.05 was considered statisti cally significant.Results There was no significant difference between the two groups of intraoperative bleeding,operation time and hospitalization time（all P〉0.05）.The time of bone healing in the study group was shorter than that of the control group,and the difference was statistically significant（P〈0.05）.After 6 months,compared with the control group,the activity of external rotation,internal rotation and flexion and extension of elbow joint in the study group increased,and the value of elbow extension muscle strength decreased.The difference was statistically significant（all P〈0.05）.The total excellent rate of the study group（89.47%）was compared with the control group（75.68%）,but the difference was not statistically significant（P〉0.05）.Compared with the control group 6 months after the operation,the scores of Mayo and SF-36 in the study group increased and the DASH score decreased.The differences were statistically significant（all P〈0.05）.The incidence of postoperative complications in the study group（5.26%）was lower than that of the control group（24.32%）,and the difference was statistically significant（P〈0.05）.Conclusion Schildhauer approach on open reduction and internal fixation in patients with type C fracture of the distal humerus is effective.It can obviously promote the healing of the fracture,increase the mobility of the elbow joint,accelerate the recovery of the elbow joint function,improve the quality of life of the elbow joint and reduce the occurrence of complications.