Schildhauer入路与鹰嘴截骨入路复位内固定治疗肱骨远端C型骨折的疗效对比研究  

A comparative study of Schildhauer approach and olecranon osteotomy approach in the treatment of type C distal humeral fractures

作　　者：朱广伟[1] 张大伟[2] 王丹[3] 高虎方 张新潮 ZHU Guang-wei;ZHANG Da-wei;WANG Dan;GAO Hu-fang;ZHANG Xin-chao(Department of Osteoarticular Surgery,Sanmenxia Central Hospital,Sanmenxia,Henan 472000,China;Department of Upper Limb,Zhengzhou Orthopaedic Hospital,Zhengzhou,Henan 450000,China;The First Department of Orthopedics,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Orthopedics,Jinshan Hospital Affiliated to Shanghai Fudan University,Shanghai 200540,China)

机构地区：[1]三门峡市中心医院骨关节外科,河南三门峡472000 [2]郑州市骨科医院上肢科,郑州450000 [3]郑州大学第一附属医院骨一科,郑州450052 [4]上海复旦大学附属金山医院骨科,上海200540

出　　处：《创伤外科杂志》2020年第11期840-843,共4页Journal of Traumatic Surgery

基　　金：2017年河南省医学科技攻关计划项目(201703175)。

摘　　要：目的探讨Schildhauer入路与鹰嘴截骨入路复位内固定治疗肱骨远端C型骨折的疗效。方法前瞻性选取2014年5月—2019年2月三门峡市中心医院骨关节外科收治的150例肱骨远端C型骨折患者,男性67例,女性83例;年龄33~61岁,平均51.0岁。致伤原因道路交通伤76例,高处坠落伤38例,平地跌倒36例。患者随机分为两组,鹰嘴截骨入路组(75例)采用鹰嘴截骨入路切开复位内固定治疗,Schildhauer入路组(75例)采用Schildhauer入路切开复位内固定治疗。患者均术后随访1年。比较两组手术相关指标、肘关节功能、生活质量和并发症差异。结果Schildhauer入路组手术时间、术中出血量少于鹰嘴截骨入路组(102.56±12.05)min vs.(151.23±13.57)min;(107.25±15.29)mL vs.(132.35±16.35)mL,P<0.05,术后12个月Mayo肘关节功能(MEPS)评分优良率高于鹰嘴截骨入路组(88%vs.75%,P<0.05),患侧肘关节屈伸、内旋、外旋角度均大于鹰嘴截骨入路组(125.35±14.62)°vs.(118.23±11.35)°;(91.35±5.32)°vs.(80.32±4.23)°;(91.34±6.35)°vs.(79.42±5.05)°,P<0.05,健康状况调查简表(SF-36)评分均高于鹰嘴截骨入路组(66.88±11.23)分vs.(55.13±7.13)分,P<0.05。两组术后住院时间、骨折愈合时间、并发症发生率比较差异无统计学意义(P>0.05)。结论与鹰嘴截骨入路比较,Schildhauer入路可减少手术创伤,节省手术时间,改善肘关节功能和生活质量,更适合肱骨远端C型骨折的治疗。但对于C3型不截骨,显露和固定有一定困难,临床技术要求较高。Objective To investigate the effect of reduction and internal fixation via Schildhauer approach and olecranon osteotomy approach on type C fracture of distal humerus.Methods Totally 150 patients with type C fracture of distal humerus who admitted Sanmenxia Central Hospital from May 2014 to Feb.2019 were selected prospectively,including 67 males and 83 females,aged 33 to 61 years,with an average age of 51.0 years.The causes of injury were traffic accident in 76 cases,high falling injury in 38 cases and flat falling in 36 cases.Patients were randomly divided into two groups.The olecranon osteotomy group(75 cases)was treated by reduction and internal fixation via olecranon osteotomy,and the schildhauer group(75 cases)was treated by reduction and internal fixation via Schildhauer.All patients were followed up for one year.The differences of operation related indexes,elbow joint function,quality of life and complications between the two groups were observed.Results The operation time and bleeding volume in the observation group were less than those in the control group[(102.56±12.05)min vs.(151.23±13.57)min;(107.25±15.29)mL vs.(132.35±16.35)mL,P<0.05].At 12 months after operation,the excellent and good rate of Mayo Elbow Performance Score(MEPS)was higher than that of the olecranon osteotomy group(88%vs.75%,P<0.05).The angle of flexion and extension,internal rotation and external rotation of elbow joint in the affected side were higher than those in the olecranon osteotomy group[(125.35±14.62)°vs.(118.23±11.35)°;(91.35±5.32)°vs.(80.32±4.23)°;(91.34±6.35)°vs.(79.42±5.05)°,P<0.05].The score of health status survey(SF-36)was higher than that of the olecranon osteotomy group[(66.88±11.23)points vs.(55.13±7.13)points,P<0.05].There was no significant difference between the two groups in postoperative hospitalization time,fracture healing time and complication rate(P>0.05).Conclusion Compared with the olecranon osteotomy approach,Schildhauer approach can reduce the operative trauma,save the operative time,im

关 键 词：肱骨远端骨折 入路 复位 肘关节功能 

分 类 号：R683.41[医药卫生—骨科学]