两种肘后入路双垂直钢板置入内固定治疗肱骨远端C型骨折  

Perpendicular double-locking plating system for the internal fixation of type C distal humerus fractures through two kinds of postcubital approaches

作　　者：李云鹏 赵文志[1] 

机构地区：[1]大连医科大学附属第二医院创伤骨科,辽宁省大连市116021

出　　处：《中国组织工程研究》2017年第27期4324-4329,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:肱骨远端骨折常为粉碎性且解剖结构特殊,其复位及固定非常困难,何种手术入路处理此骨折更具有优势在目前临床研究中仍存在争议。目的:对比分析两种肘后入路双垂直锁定钢板内固定修复肱骨远端C型骨折的疗效。方法:将符合标准的32例肱骨远端C型骨折患者根据手术入路分为2组,尺骨鹰嘴截骨入路组18例,肱三头肌舌肌瓣入路组14例,确定2组患者在年龄、损伤机制、骨折分型等方面差异无显著性意义。对患者的手术时间、术中出血量、住院时间、愈合时间及术后随访功能及并发症的发生情况进行统计,术后1,3,6个月、1年及1年半随访。根据临床检查及影像学检查记录骨折愈合时间及并发症,术后1年采用Mayo评分评价肘关节功能。结果与结论:①尺骨鹰嘴截骨入路组患者较肱三头肌舌肌瓣入路组手术时间更长、术中出血更多(P<0.05),但是预后肘关节屈曲及伸展角度更大(P<0.05),术后1年肘关节功能更优(P<0.05);②两入路在骨折愈合时间等方面差异无显著性意义(P>0.05);③综上,肘后两种入路均能良好显露肱骨远端骨折关节面,双垂直钢板能够有效固定肱骨远端C型骨折。肱三头肌舌肌瓣入路术中损伤更小,尺骨鹰嘴截骨入路预后拥有更好的肘关节功能和更少的并发症。BACKGROUND： Distal humerus fracture is often comminuted, and is difficult to receive reduction and fixation due to its special anatomical structure. Choosing which surgical approach is still a controversy.OBJECTIVE： To compare and analyze the curative efficacy of the perpendicular double-locking plating system for the internal fixation of type C distal humerus fractures through two kinds of postcubital approaches.METHODS： Thirty-two cases of type C distal humerus fractures were enrolled and divided into groups A （osteotomy of olecranon approach） and B （tricep anconeus flap approach）. There was no significant difference in the baseline data between two groups. The operation time, intraoperative blood loss, hospital stay, healing time,postoperative follow-up and complications were recorded and analyzed. The patients were followed up at 2 weeks, 1, 3,6, 12, and 18 months. The healing time and complications were recorded according to radiographs and physical examinations. The Mayo Elbow Performance Score was used to determine the elbow function at 1 year postoperatively.RESULTS AND CONCLUSION： （1） The group A had a longer operation time and more intraoperative blood loss than those in the group B （P 0.05）. （3） These results suggest that the articular surface of the distal humerus fracture is displayed well through two approaches, and the perpendicular double-locking plating system for the internal fixation of type C distal humerus fractures is rational. Noticeably, the tricep anconeus flap approach dose little damage to the muscle, while the osteotomy of olecranon approach obtains better elbow function and less complications.

关 键 词：骨科植入物 骨植入物 肱骨远端骨折 手术入路 内固定 

分 类 号：R318[医药卫生—生物医学工程]