两种不同手术入路治疗肱骨髁间骨折疗效分析

Analysis of Two Different Surgical Approaches for the Treatment of Intercondylar Fracture of Humerus

目的对比分析经肱三头肌双侧入路和经尺骨鹰嘴截骨入路治疗成人肱骨髁间骨折的临床疗效。方法总结分析2008年7月—2017年6月我院诊治的47例成人肱骨髁间骨折并获得完整回访的临床资料,其中经过肱三头肌双侧入路手术治疗25例(A组),经过尺骨鹰嘴截骨入路手术治疗22例(B组);对两组术中手术时间、术中X线暴露时间、术后并发症及肘关节功能恢复情况进行对比分析。结果两组手术前一般资料对比,差异无统计学意义(P>0.05);A组手术时间优于B组,但两组数据对比,差异无统计学意义(P>0.05),B组术中X线暴露时间少于A组,差异具有统计学意义(P<0.05),两组手术后并发症及肘关节功能恢复情况对比,差异无统计学意义(P>0.05)。结论经肱三头肌双侧入路和经尺骨鹰嘴截骨入路治疗成人肱骨髁间骨折均可以获得良好的治疗效果,两组手术时间、术后并发症及肘关节功能恢复情况无明显差异,但是尺骨鹰嘴截骨入路对于关节面的显露优于经肱三头肌双侧入路,致使经肱三头肌双侧入路手术的X线暴露时间长于对照组,对于肱骨远端C3型骨折推荐尺骨鹰嘴截骨入路。

Objective To compare the clinical effect of the bilateral approach of triceps brachii and the olecranon osteotomy in the treatment of the intercondylar fracture of the humerus in adults.Methods The clinical data of 47 cases of adult humeral intercondylar fracture treated in our hospital from July 2008 to June 2017 were analyzed and analyzed.25 cases(group A)were treated by bilateral triceps brachii approach.22 cases(group B)were treated by olecranon osteotomy.The operation time,the exposure time of X-ray,the postoperative complications and the recovery of the function of the elbow joint were compared and analyzed in the two groups.Results There was no statistical difference between the two groups before operation(P>0.05).The operation time of group A was better than that of group B,and there was no statistical difference between the two groups(P>0.05).The X-ray exposure time in group B was less than that in group A,and the difference was statistically significant(P<0.05).There was no significant difference in the postoperative complications and the recovery of the elbow joint function between the two groups(P>0.05).Conclusion The treatment of the intercondylar fracture of the humerus of the humerus through the bilateral approach of the triceps brachii and the olecranon osteotomy in the ulna can achieve good therapeutic effect.There was no significant difference in the operation time,postoperative complications and the recovery of the elbow joint function between the two groups.However,the ulnar olecranon osteotomy approach is better than the triceps brachii approach in exposing the articular surface,resulting in a longer exposure time than the control group through bilateral triceps brachii approach.The ulna olecranon osteotomy approach is recommended for the distal humerus type C3 fracture.