经肱三头肌内外侧入路固定肱骨远端关节内骨折的疗效分析

Surgical treatment of distal humeral intra-articular fractures in adults through the medial-lateral triceps approach

目的分析经肱三头肌内外侧入路固定肱骨远端关节内骨折的疗效。方法回顾性分析2017年1月至2021年12月在南京医科大学康达学院附属连云港市东方医院骨科经肱三头肌内外侧入路治疗的28例肱骨远端关节内骨折患者资料。骨折按照AO分型:B型15例,C型13例。经肱三头肌内外侧入路提起肱三头肌显露肱骨远端关节内骨折端进行复位和固定。观察患者的骨折愈合时间、骨折复位情况、术后并发症的发生情况,比较患者术后第2天和末次随访时的肱骨远端关节内骨折复位的Rasmussen放射学评分。末次随访时按照Mayo肘关节功能评分(MEPS)评价肘关节功能。结果所有患者术后随访(23.4±3.9)个月。术后切口均一期愈合,X线片示所有螺钉位置良好,骨折复位满意。骨折愈合时间为(15.9±2.7)周;异位骨化1例,迟发性尺神经炎1例。术后第2天Rasmussen放射学评分(17.3±1.1)分和末次随访时(17.1±1.5)分比较,差异无统计学意义(t=1.800,P=0.083)。末次随访时MEPS评分为(86.1±13.8)分,其中优19例,良6例,中2例,差1例,优良率为89.3%(25/28)。结论经肱三头肌内外侧入路治疗肱骨远端关节内骨折,不切断肱三头肌及其附丽点,提起肱三头肌可增加骨折端的显露,组织损伤小,允许术后早期肘关节功能锻炼,疗效肯定。

ObjectiveTo investigate the clinical efficacy of the medial-lateral triceps approach in the surgical treatment of distal humeral intra-articular fractures in adults.MethodsFrom January 2017 to December 2021,a total of 28 adults with distal humeral intra-articular fracture were treated at Department of Orthopaedics,Lianyungang Oriental Hospital Affiliated to Kangda College of Nanjing Medical University through the medial-lateral triceps approach.According to the AO classification,there were 15 cases of type B and 13 cases of type C.The triceps brachii muscle was lifted through the medial-lateral triceps approach to expose the distal end of the distal humeral intra-articular fracture for reduction and fixation.The fracture healing time,fracture reduction,and incidence of postoperative complications were observed.The Rasmussen radiological scores for the reduction of the distal humeral intra-articular fracture were compared between the second day after surgery and the last follow-up.The elbow function at the last follow-up was assessed using Mayo elbow performance score(MEPS).ResultsThe follow-up duration was(23.4±3.9)months for this cohort.All incisions healed at one stage.All fractures obtained anatomical reduction with satisfactory screw positions on the X-ray after(15.9±2.7)weeks.Heterotopic ossification happened in 1 case and late-onset ulnar neuritis in 1 case.There was no statistically significant difference in the Rasmussen radiological score between the second day after surgery[(17.3±1.1)points]and the last follow-up[(17.1±1.5)points](t=1.800,P=0.083).The mean MEPS at the last follow-up was(86.1±13.6)points;19 cases were rated as excellent,6 as good,2 as fair and 1 as poor,giving an overall excellent and good rate of 89.3%(25/28).ConclusionIn the treatment of distal humeral intraarticular fractures via the medial-lateral triceps approach,the olecranon insertion of the triceps tendon is not severed and the triceps can be lifted to increase surgical exposure and reduce tissue damage.Therefore,early postoperative elbow exercise can be carried out to assure definite therapeutic efficacy.