经后方正中切口肱三头肌两侧分离入路与尺骨鹰嘴截骨入路治疗肱骨髁间骨折的疗效比较

Bilateral separation approach of triceps through posterior median incision versus ulnar olecranon osteotomy approach in the treatment of humeral intercondylar fractures

目的探讨尺骨鹰嘴截骨入路与经后方正中切口肱三头肌两侧分离入路治疗肱骨髁间骨折的临床疗效。方法回顾性分析2019年3月—2020年3月商丘市第一人民医院急诊创伤外科收治的98例肱骨髁间骨折患者的临床资料。男性57例,女性41例;年龄24~78岁,平均42.8岁;AO/OTA分型:C1型20例,C2型51例,C3型27例;致伤原因:平地摔伤13例,道路交通伤46例,高处坠落伤39例。根据手术方法不同分为A组(采用肱三头肌两侧分离入路,n=50)和B组(采用尺骨鹰嘴截骨入路,n=48)。比较两组手术相关指标、术后恢复指标、Mayo肘关节功能评分(MEPS)以及并发症发生情况。结果A组术中出血量(195.0±28.9)mL多于B组(158.8±19.1)mL,手术时间(129.4±35.4)min和术后住院时间(9.8±2.0)d长于B组[(106.1±22.2)min,(7.4±2.5)d],差异均有统计学意义(P<0.001)。两组骨折愈合时间、关节屈伸活动度和肘关节旋转活动度相比,差异均无统计学意义(P>0.05)。A组术后1个月MEPS(54.1±9.1)分高于B组(47.1±9.1)分,差异有统计学意义(P<0.001);两组术后3、6、12个月MEPS相比,差异无统计学意义(P>0.05)。两组并发症发生率比较(18.0%vs.16.7%),差异无统计学意义(P>0.05)。结论经后方正中切口肱三头肌两侧分离入路与尺骨鹰嘴截骨入路治疗肱骨髁间骨折均有较好的临床疗效,肘关节功能恢复较好,而肱三头肌两侧分离入路相对于尺骨鹰嘴截骨入路,其手术时间较长、术中出血较多,对术者的操作水平要求较高,不适用于体弱者。临床上应视具体情况,个性化选择合适的方案。

Objective To compare the clinical efficacy between ulnar olecranon osteotomy approach and bilateral separation approach of triceps through posterior median incision in the treatment of humeral intercondylar fractures.Methods Clinical data of 98 patients with humeral intercondylar fractures who were admitted to Shangqiu First People’s Hospital from Mar.2019 to Mar.2020 were retrospectively analyzed.There were 57 males and 41 females aged 24-78(mean 42.8)years.AO/OTA classification revealed 20 cases of type C1,51 type C2 and 27 type C3,with 13 due to ground-level falls,46 to road traffic accidents,and 39 to falls from height.Patients were divided into Group A,in which bilateral separation approach of triceps was conducted(n=50),and Group B,in which ulnar olecranon osteotomy approach was conducted(n=48).The surgery-related indicators,postoperative recovery indicators,Mayo elbow performance score(MEPS),and incidence of complications were compared between two groups.Results Group A showed more intraoperative bleeding(mL,195.0±28.9 vs.158.8±19.1),and longer operation time(min,129.4±35.4 vs.106.1±22.2)and length of hospital stay(d,9.8±2.0 vs.7.4±2.5),all with significant difference compared with Group B(P<0.001).The fracture healing time,joint flexion and extension range of motion(ROM)and elbow joint rotational ROM showed no significant difference(P>0.05).The MEPS was much higher in Group A than in Group B at 1 month after surgery(54.1±9.1 vs.47.1±9.1,P<0.001);after that,the differences were insignificant(P>0.05 at 3,6 and 12 months after surgery).The incidence of complications revealed no significant differences either(18.0%vs.16.7%,P>0.05).Conclusion Both the investigated approaches show good clinical effects in the treatment of humeral intercondylar fractures,with well-recovered elbow joint function.Moreover,the bilateral separation approach of triceps through posterior median incision(Group A),though can achieve an earlier functional recovery,is more technique-demanding with longer operation time and more intraoperative blood loss and thus is unsuitable for physically weak patients.Individualized surgical plans should be made based on the patient’s condition.