肘关节外侧入路脱位法与非脱位法复位内固定治疗肱骨远端冠状面骨折的疗效比较

Efficacy comparison of lateral elbow dislocation approach and non-dislocation approach for reduction and internal fixation of distal humeral coronal fracture

目的比较肘关节外侧入路脱位法与非脱位法复位内固定治疗肱骨远端冠状面骨折的临床疗效。方法采用回顾性队列研究分析2018年1月至2021年10月山东大学齐鲁医院(青岛)收治的26例肱骨远端冠状面骨折患者的临床资料,其中男10例,女16例;年龄15~80岁[(51.6±4.9)岁]。Dubberley分型:2A型10例,2B型5例,3A型6例,3B型5例。12例采用肘关节外侧入路脱位法行骨折复位内固定(脱位法组),14例采用肘关节外侧入路传统显露方法行骨折复位内固定(非脱位法组)。比较两组手术时间、术中出血量、切口愈合情况、术后1周内三维CT评估复位情况(分离或台阶>2 mm为差)、术后3个月Mayo肘关节功能评分(MEPS)、末次随访时骨折愈合情况。比较两组并发症情况。结果患者均获随访3~18个月[(10.5±3.3)个月]。脱位法组、非脱位法组手术时间分别为(146.9±15.5)min、(122.7±11.1)min(P>0.05);术中出血量分别为(113.3±9.7)ml、(112.9±10.1)ml(P>0.05)。术后切口均Ⅰ期愈合。脱位法组复位均良好,而非脱位法组7例复位良好,7例关节面后方发现分离或台阶>2 mm(P<0.05)。术后3个月脱位法组MEPS为(90.0±1.4)分,其中优9例,良3例,优良率为100%;非脱位法组MEPS为(78.9±2.9)分,其中优5例,良4例,中4例,差1例,优良率为64.3%(P<0.05)。末次随访时骨折均愈合。非脱位法组7例关节退变,其中3例螺钉切割,2例异位骨化,2例高龄患者单纯关节周围有骨赘形成;脱位法组2例高龄患者关节退变,单纯骨赘形成,未发现螺钉切割及异位骨化。结论对于肱骨远端冠状面骨折,肘关节外侧入路脱位法复位内固定较非脱位法可以完全显露肱骨远端关节面,骨折解剖复位,肘关节功能恢复好,并发症少。

Objective To compare the efficacy of lateral elbow dislocation approach with non-dislocation approach for open reduction and internal fixation of distal humeral coronal fracture.Methods A retrospective cohort study was used to analyze the clinical data of 26 patients with distal humeral coronal fracture admitted to Qilu Hospital(Qingdao)of Shandong University from January 2018 to October 2021,including 10 males and 16 females,aged 15-80 years[(51.6±4.9)years].According to Dubberley classification,there were 10 patients with type 2A,5 with type 2B,6 with type 3A and 5 with type 3B.Overall,12 patients were operated via lateral elbow dislocation approach(dislocation approach group)and 14 via lateral elbow non-dislocation approach(non-dislocation approach group).The operation time,intraoperative bleeding volume,incision healing,three-dimensional CT assessment of the reduction within one week after surgery(separation or step>2 mm as poor),Mayo elbow performance score(MEPS)at 3 months after surgery and fracture healing at the last follow-up were recorded in both groups.Complications were also compared between the two groups.Results All patients were followed up for 3-18 months[(10.5±3.3)months].The operation time was(146.9±15.5)minutes in dislocation approach and(122.7±11.1)minutes in non-dislocation approach group(P>0.05).The intraoperative bleeding volume was(113.3±9.7)ml in dislocation approach and(112.9±10.1)ml in non-dislocation approach group(P>0.05).All incisions healed uneventfully in stage I.All patients had good reduction in dislocation group,while only 7 patients had good reduction and the other 7 patients presented a separation or step>2 mm in non-dislocation group(P<0.05).The MEPS was(90.0±1.4)points in dislocation approach group at 3 months after surgery,including 9 patients being rated as excellent and 3 good,with the excellent and good rate of 100%.In constrast,the MEPS was(78.9±2.9)points in non-dislocation approach group at 3 months after surgery,including 5 patients being rated as excellent,4 good,4 fair and 1 poor,with the excellent and good rate of 64.3%(P<0.05).All fractures were healed at the last follow-up.In non-dislocation approach group,osteoarthritis occurred in 7 patients,including 3 with screw protrusion,2 with heterotopic ossification and 2 of advanced age with osteophyte formation around the joint.In dislocation approach group,osteoarthritis occurred only in 2 patients of advanced age,showing osteophyte formation around the elbow joint,with no screw cutting or heterotopic ossification.Conclusion For distal humeral coronal fracture,the lateral elbow dislocation approach is able to provide complete exposure of the articular surface,obtain anatomic reduction,restore elbow function and reduce complications when compared with the non-dislocation approach.