钢板固定尺神经原位还纳与前置治疗肱骨髀间骨折的疗效比较

Efficacy comparison between plate fixation with in situ reinforcing ulnar nerve and anterior transposition for humeral intercondylar fracture

目的探讨尺神经原位还纳与前置在经尺骨鹰嘴入路钢板治疗C2、C3型肱骨課间骨折的临床疗效。方法采用回顾性病例对照研究分析2014年6月一2017年1月杭州师范大学附属医院收治的23例肱骨課间骨折患者临床资料,其中男17例,女6例;年龄19~56岁,平均41.2岁。A0分型:C2型15例,C3型8例。均采用经尺骨鹰嘴截骨入路钢板内固定。11例行尺神经松解前置术(前置组),12例行尺神经松解原位还纳(原位还纳组)。比较两组手术时间、术中出血量、骨折愈合时间、肘关节屈伸活动范围、肘关节May。评分及优良率。观察术后并发症情况。结果患者均获随访15-43个月,平均26.7个月。患者均未输血。前置组和原位还纳组手术时间[(219.1±15.1)min:(211.2±17.1)min]、术中出血量[(263.6±35.3)ml:(237.5±25.6)ml]和骨折愈合时间[(18.2±2.4)周:(18.9±1.7)周]差异均无统计学意义(P>0.05),而肘关节屈曲度[(120.3±7.1)°:(120.3±4.1)°]、伸直度[(3.7±2.7)°:(4.1±2.4)°]、Mayo评分[(89.09±9.17)分:(86.67±10.29)分]及优良率[91%(10/12):83%(10/12)]差异亦均无统计学意义(P>0.05)。术后均未出现感染、异位骨化、尺神经炎、肘内外翻畸形或内固定断裂等并发症。结论对于肱骨課间骨折,经尺骨鹰嘴截骨入路钢板固定尺神经原位还纳与前置均具有手术创伤较小、固定坚强、并发症少、肘关节功能恢复满意等优点,尺神经前置与否并不影响尺神经炎的发生,均可获得满意的临床疗效。

Objective To investigate the clinical efficacy of plate fixation with in situ reinforcing ulnar nerve and anterior transposition by olecranon osteotomy approach in the treatment of type C2 and C3 humeral intercondylar fractures.Methods A retrospective case control study was conducted to analyze the clinical data of 23 patients with humeral intercondylar fractures admitted to the Affiliated Hospital of Hangzhou Normal University from June 2014 to January 2017.There were 17 males and six females,aged 19-56 years,with an average of 41.2 years.According to AO classification,there were 15 patients with type C2 and eight with type C3.All patients were treated with plate internal fixation by olecranon osteotomy approach.The patients were divided into anterior group(11 patients)which was treated with ulnar nerve release anterior transposition and in situ reinforcing group(12 patients)which was treated with ulnar nerve release in situ.The operation time,intraoperative blood loss,fracture healing time,elbow flexion and extension range,elbow joint Mayo score,and excellent and good rate were compared between the two groups.Postoperative complications were recorded.Results All patients were followed up for 15-43 months,with an average of 26.7 months.All patients had no need of blood transfusion.There were nosignificant differences between anterior group and in situ reinforcing group in operation time[(219.1±15.1)minutes vs.(211.2±17.1)minutes],intraoperative blood loss[(263.6±35.3)ml vs.(237.5±25.6)ml]and fracture healing time[(18.2±2.4)weeks vs.(18.9±1.7)weeks](P>0.05).No significant differences were found between the two groups in elbow flexion[(120.3±7.1)°vs.(120.3±4.1)°],straightness[(3.7±2.7)°vs.(4.1±2.4)°],Mayo score[(89.09±9.17)points vs.(86.67±10.29)points]and excellent and good rate[91%(10/12)vs.83%(10/12)](P>0.05).After operation,no complications such as infection,heterotopic ossification,ulnar neuritis,elbow valgus deformity,or internal fixation failure occurred.Conclusions For humeral intercondylar fracture,the plate fixation with in situ reinforcing ulnar nerve and anterior transposition by olecranon osteotomy approach both have advantages such as small surgical trauma,strong fixation,fewer complications,satisfactory recovery of elbow function.Ulnar nerve anterior transposition or not does not affect the occurrence of ulnar neuritis,and both can obtain satisfactory clinical efficacy.