改良肘肌瓣入路治疗肱骨髁间骨折  

Modified anconeus flap approach for intercondylar humerus fractures

作　　者：孙焕建[1] 吴加东[1] 朱文峰[1] 夏春林[2] 刘璠[3] 

机构地区：[1]东南大学附属盐城医院骨科,江苏省盐城市224001 [2]苏州大学博习临床解剖研究所,215123 [3]南通大学附属医院骨科,226001

出　　处：《中华创伤骨科杂志》2016年第7期586-591,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨新设计的改良肘肌瓣入路（肘肌一部分肱三头肌翻转入路）治疗肱骨远端髁间骨折（AO分型C型）的疗效及技术要点。方法选取成人尸体标本15具（30侧），研究肱三头肌远端肌腱及肘肌的解剖特点，设计改良肘肌瓣入路，将其就肱骨远端的显露面积与肱三头肌完全翻转肘肌蒂入路（TRAP）相比。选取2005年5月至2013年5月诊断为肱骨髁间骨折（AO分型C型）患者16例，采用改良肘肌瓣入路（肘肌一部分肱三头肌翻转）进行手术，评估末次随访时Mayo肘关节功能评分（MEPS）及Broberg＆Morrey评分。结果肱三头肌肌腱桡侧劈裂时紧贴肌内肌腱对肘肌血管神经影响的几率最小；在肘关节屈伸0～150°范围内，改良肌瓣入路显露肘关节面积占肱骨远端关节面面积的百分比平均为42．66％±0．03％，TRAP入路平均为46．11％±0．03％，差异有统计学意义（P〈0．05）。16例患者中15例获完整随访，时间6个月至4年（平均16．5个月）。末次随访时MEPS评分为82-93分（平均90．5分），优10例，良4例，差1例；Broberg＆Morrey评分示11例患者无退变（0级），3例患者1级退变，1例患者2级退变。结论改良肘肌瓣入路治疗肱骨髁间骨折手术显露清楚，不需要尺骨鹰嘴截骨，肱三头肌肌腱主要部分无需从鹰嘴剥离或切断，能够满足绝大多数肱骨远端髁问骨折复位内固定的要求。术后可早期功能锻炼，治疗效果满意。Objective To report a new surgical approach （modified anconeus flap approach） in which the anconeus and part of triceps are reflected in the treatment of distal intercondylar humerus fracture （AO type C）. Methods To design the modified anconeus flap approach, the anatomy of the distal tendon of the triceps brachii and the anconeus was studied using 15 cadaveric adult specimens （30 sides）. The new surgical approach was compared with the triceps-reflecting anconeus pedicle （TRAP） approach in terms of the area of exposure at the distal humeral articular surface. Furthermore, the new surgical approach was applied in 16 patients who had been treated for intercondylar humerus fracture （AO type C） from May 2005 to May 2013. The clinical outcomes were evaluated using the Mayo elbow performance score （MEPS） and Broberg-Morrey scoring systems. Results The blood supply and innervation of the anconeus was inter- rupted minimally during incision along the radical edge of triceps tendon. The area of exposure at the distal humeral articular surface provided by the part triceps and anconeus reflecting approach and the medial humerus approach was 42. 66% ± 0.03% at the elbow flexion from 0° to 50°. This was significantly smaller than that provided by the TRAP approach （46. 11% ± 0.03% ） （ P 〈 0.05）. Of the 16 patients, 15 obtained complete follow-ups from 6 months to 4 years（average, 16.5 months）. The mean MEPS at the last follow-up was 90.5 points （range, from 82 to 93 points）, with 10 excellent and 4 good cases and one poor case. The Broberg ＆ Morrey score system showed 11 patients with no articular cartilage degeneration （level-0）, 3 patients with level-1 degeneration, and 2 patients with level-2 degeneration. Conclusion The modified anconeus flap approach proposed in the present study provides clear surgical vision and needs no olecranon osteotomy or olecranon dissection or ablation of the major triceps brachii tendon for intercondylar humerus fractures, thereby leading to e

关 键 词：肱骨骨折 尸体解剖 治疗 临床研究性 手术入路 

分 类 号：R687.3[医药卫生—骨科学]