经尺骨鹰嘴截骨入路与肱三头肌两侧入路治疗肱骨髁间骨折的疗效比较

Comparison analysis of the effects of transulnar olecranon osteotomy and bilateral triceps approach for fixation of intercondylar fracture of the humerus

目的 探讨经尺骨鹰嘴截骨入路与肱三头肌两侧入路切开复位双钢板固定C2、C3型肱骨髁间骨折的临床效果。方法 回顾性分析2013年1月-2018年1月行手术固定的60例肱骨髁间骨折的病历资料。32例采用经尺骨鹰嘴截骨入路固定(截骨组),28例采用经肱三头肌两侧入路固定(未截骨组)。比较两组病例手术时间、术中出血量、术后尺神经炎发生率、骨折平均愈合时间、随访肘关节活动度、肘关节Mayo评分以及术后并发症及二次手术情况。结果 术后所有患者均获随访,随访时间12~36个月,平均22.5个月。截骨组与未截骨组骨折平均愈合时间、肘关节活动度、肘关节Mayo评分,差异无统计学意义(P>0.05)。截骨组手术时间相较未截骨组更短,术中出血量更少,差异有统计学意义(P <0.05)。两组术后随访均未出现感染、复位丢失、创伤性关节炎、骨折不愈合、骨折畸形愈合等并发症。截骨组5例、未截骨组6例术后出现尺神经炎症状,均于术后3个月内缓解。截骨组及未截骨组各有1例二期再次行肘关节松解术。结论 对于复杂的C2、C3型肱骨髁间骨折,采用尺骨鹰嘴截骨入路或肱三头肌两侧入路,可获得足够的手术视野,坚强稳固的骨折固定,是理想的手术方法。

Objective To explore the clinical effect of olecranon osteotomy and open reduction with twosided triceps brachii approach to fix C2 and C3 humeral intercondylar fractures.Methods The medica records of 60 patients with humeral intercondylar fractures who underwent surgical fixation from January2013 to January 2018 were retrospectively analyzed.Thirty-two cases were fixed by the transulnar olecranon osteotomy approach (osteotomy group),and 28 cases were fixed by the triceps bilateral approach (nonosteotomy group).The operation time,intraoperative blood loss,postoperative ulnar neuritis incidence,average fracture healing time,followed-up elbow joint range of motion,elbow joint Mayo score,postoperative complications and secondary operations were compared between two groups.Results Al patients in this group were followed up for 12 to 36 months,with an average of 22.5 months.There was no significant difference between the osteotomy group and the non-osteotomized group in the average fracture healing time,elbow joint range of motion,and elbow joint Mayo score (P>0.05).Compared with the nonosteotomized group,the operation time of the osteotomy group was shorter,and the intraoperative bleeding was less.The difference was statistically significant (P<0.05).There were no complications such as infection,loss of reduction,traumatic arthritis,nonunion of fractures,and malunion of fractures in the follow-up of two groups.Five patients in the osteotomy group and 6 patients in the non-osteotomized group developed new symptoms of ulnar neuritis after surgery,and all relieved within 3 months after surgery.In the osteotomy group and the non-osteotomized group,1 patient underwent the second-stage elbow joint lysis.Conclusion For complex C2 and C3 humeral intercondylar fractures,using olecranon osteotomy or both sides of the triceps brachii approach can obtain sufficient surgical vision,strong and stable fractures,and obtain ideal surgical results.