尺骨鹰嘴截骨入路联合远端双钢板固定治疗肱骨远端粉碎性骨折的效果观察

Observation of the Effect of Ulna Olecranon Osteotomy Approach Combined with Distal Double Plate Fixation in the Treatment of Comminuted Distal Humeral Fracture

目的探讨尺骨鹰嘴截骨入路联合远端双钢板固定治疗肱骨远端粉碎性骨折的效果。方法选取2017年4月—2018年5月收治的肱骨远端粉碎性骨折患者65例,根据手术治疗方法的不同分为观察组33例和对照组32例。对照组采用肱三头肌造瓣入路联合克氏针内固定治疗,观察组应用尺骨鹰嘴截骨入路联合远端双钢板固定治疗。比较2组术中出血量、手术时间、切口长度、骨折愈合时间,术后随访1年时应用Cassebaum肘关节功能评分评估2组肘关节功能恢复总有效率。比较2组术前及术后1年时健康状况调查简表(SF-36)评分以评估术后生活质量,观察2组术后并发症发生情况。结果观察组术中出血量少于对照组,手术时间、切口长度、骨折愈合时间均短于对照组(P<0.05)。观察组肘关节功能恢复总有效率高于对照组,术后并发症总发生率低于对照组(P<0.05)。术后1年,2组SF-36评分均较治疗前明显升高,且观察组SF-36评分升高程度大于对照组(P<0.05或P<0.01)。结论尺骨鹰嘴截骨入路联合远端双钢板固定治疗肱骨远端粉碎性骨折效果显著,可有效减少术中出血量,缩短手术时间、骨折愈合时间,提高术后生活质量,降低术后并发症发生率。

Objective To investigate the effect of ulna olecranon osteotomy approach combined with distal double plate fixation in the treatment of comminuted distal humeral fracture.Methods Sixty-five patients with comminuted distal humerus fractures admitted from April 2017 to May 2018 were selected and divided into observation group(n=33)and control group(n=32)according to different surgical treatment methods.The control group was treated with triceps flap approach combined with kirschner needle internal fixation,and the observation group was treated with ulna olecranon osteotomy approach combined with distal double plate fixation.The amount of bleeding,duration of operation,incision length,duration of fracture healing of the two groups were compared,the Cassebaum elbow function score was used to assess the total effective rate of elbow function recovery at 1-year postoperative follow-up.The SF-36 score was used to assess the postoperative quality of life before and 1-year after operation,and the incidence of complications after operation was observed in both groups.Results The amount of bleeding in the observation group was less than that in the control group,and the duration of operation,incision length,duration of fracture healing were shorter than those in the control group(P<0.05).The total effective rate of elbow joint function recovery in the observation group was higher than that in the control group,and the total incidence of postoperative complications was lower than that in the control group(P<0.05).At one year after surgery,the SF-36 scores of the two groups were significantly higher than those before treatment,but the observation group had more increased SF-36 scores than the control group(P<0.05 or P<0.01).Conclusion The ulna olecranon osteotomy approach combined with distal double plate fixation has a significant effect on the treatment of comminuted fractures of the distal humerus,which can effectively reduce the amount of intraoperative bleeding,shorten the duration of operation and fracture healing,improve the quality of life after surgery,and reduce postoperative complication rate.