肱骨髁间骨折切开复位内固定术后并发尺神经功能障碍的影响因素分析

Occurrence and Influencing Factors of Ulnar Nerve Dysfunction in Patients with Humeral Intercondylar Fracture Undergoing Open Reduction and Internal Fixation

【目的】探讨肱骨髁间骨折切开复位内固定术后并发尺神经功能障碍的影响因素。【方法】回顾性分析本院2017年1月至2019年12月收治的60例肱骨髁间骨折行切开复位内固定术患者的临床资料。记录患者的年龄、性别、骨折分型及手术入路、尺神经处置等术中相关因素,并对患者进行术后随访。根据术后是否出现尺神经功能障碍将患者分为无症状组(对照组)及有症状组(观察组),对影响患者术后出现尺神经功能障碍的危险因素进行单因素分析及多因素Logisitic回归分析。【结果】两组患者在手术入路、尺神经处置及钢板放置方面差异具有统计学意义(P<0.05);多因素Logistic回归性分析显示,手术入路中的肱三头肌两侧入路法、前置尺神经及平行放置钢板均为影响术后神经功能障碍的独立危险因素(OR=1.992、2.643、2.282,P<0.05)。【结论】肱骨髁间骨折切开复位内固定术后并发尺神经功能障碍的发生率较高,肱三头肌两侧入路、前置尺神经及钢板平行放置均为术后并发尺神经功能障碍的独立危险因素。在临床上医生应根据患者的个体差异选择合适的手术入路方式、钢板放置方式及尺神经是否前置,尽量减少术后尺神经功能障碍的发生。

【Objective】To explore the influencing factors of ulnar nerve dysfunction after open reduction and internal fixation of intercondylar fracture of humerus.【Methods】The clinical data of 60 patients with humeral intercondylar fractures treated in our hospital from January 2017 to December 2019 were analyzed retrospectively.The age,gender,fracture classification,surgical approach,ulnar nerve treatment and other intraoperative related factors were recorded,and the patients were followed up.According to whether there was ulnar nerve dysfunction after operation,the patients were divided into asymptomatic group(control group)and symptomatic group(observation group).The risk factors of ulnar nerve dysfunction were analyzed by univariate analysis and multivariate logistic regression analysis.【Results】There were significant differences in surgical approach,ulnar nerve treatment and plate placement between the two groups(P<0.05);Multivariate logistic regression analysis showed that the bilateral approach of triceps brachii,anterior ulnar nerve and parallel plate were independent risk factors for postoperative neurological dysfunction(OR=1.992,2.643,2.282,P<0.05).【Conclusion】The incidence of ulnar nerve dysfunction after open reduction and internal fixation of intercondylar fracture of humerus is high.Bilateral approach of triceps brachii,anterior ulnar nerve and parallel placement of steel plate are independent risk factors of ulnar nerve dysfunction.Clinically,doctors should choose the appropriate surgical approach,plate placement and whether the ulnar nerve is in front according to the individual differences of patients,so as to minimize the occurrence of postoperative ulnar nerve dysfunction.