两种入路肱骨小头骨折开放复位内固定比较  

Lateral approach versus olecranon osteotomy approach for open reduction and internal fixation of humeral capitellum fractures

作　　者：孟德弘 李景银[2] 王传鑫 MENG De-hong;LI Jing-yin;WANG Chuan-xin(The First Clinical Medical College of Shandong University of Traditional Chinese Medicine,Jinan 250000,China;Department of Orthopedics,Affiliated Hospital,Shandong University of Traditional Chinese Medicine,Jinan 250000,China)

机构地区：[1]山东中医药大学第一临床医学院,山东济南250000 [2]山东中医药大学附属医院运动损伤骨科,山东济南250000

出　　处：《中国矫形外科杂志》2022年第20期1836-1841,共6页Orthopedic Journal of China

摘　　要：[目的]比较肘外侧入路与鹰嘴截骨入路开放复位内固定肱骨小头Dubberley II-IIIB型骨折的临床疗效。[方法]回顾性分析2014年12月—2019年12月本院采用开放复位内固定治疗Dubberley II-IIIB型肱骨小头骨折39例患者的临床资料。依据术前医患沟通结果,21例采用外侧入路;18例采用鹰嘴截骨入路。比较两组围手术期、随访及影像学资料。[结果]两组患者均顺利完成手术,均无神经、血管损伤。外侧组手术切口长度、手术时间及出血量均显著优于截骨组(P<0.05),但截骨组术后恢复主动活动时间和透视次数显著优于外侧组(P<0.05),两组住院时间比较差异无统计学意义(P>0.05)。两组患者平均随访时间(18.74±2.65)个月。随术后时间推移,两组VAS评分显著下降,而肘伸屈ROM和肘MEPS评分显著增加(P<0.05)。术后1个月,截骨组VAS评分、MEPS评分及肘伸-屈ROM均显著优于外侧组(P<0.05),但是,术后6个月及术后12个月时两组间上述指标的差异均已无统计学意义(P>0.05)。影像方面,截骨组的骨折复位质量及骨折愈合时间均显著优于外侧组(P<0.05)。[结论]相较于外侧入路,鹰嘴截骨入路开放复位内固定DubberleyII-IIIB型骨折可以使骨折断端获得更好复位与固定稳定性,允许患者早期活动,从而取得更好的临床疗效。[Objective]To compare the clinical efficacy of lateral approach(LA)versus olecranon osteotomy approach(OOA)for open reduction and internal fixation(ORIF)of Dubberley type II-IIIB humeral capitellum fractures.[Methods]A retrospective study was con⁃ducted on 39 patients who underwent ORIF for Dubberley type II-IIIB capitellum fractures in our hospital from December 2014 to Decem⁃ber 2019.According to the results of preoperative doctor-patient communication,21 patients had ORIF performed by the LA,while the re⁃maining 18 patients were by the OOA.The perioperative,follow-up and imaging data of the two groups were compared.[Results]All the pa⁃tients in both groups had ORIF finished smoothly without serious complications,such as neurovascular injury.The LA group was signifi⁃cantly superior to the OOA group in terms of incision length,operation time and intraoperative blood loss(P<0.05),while the OOA group proved significantly superior to the LA group in terms of intraoperatively fluoroscopic times and time to resume active motion postoperative⁃ly(P<0.05),despite of no a statistically significant difference between them in term of hospital stay(P>0.05).With time of follow-up peri⁃od lasted for(18.74±2.65)months on an average,the VAS scores decreased significantly(P<0.05),whereas the elbow flexion extension range of motion(ROM)and Mayo Elbow Performance Score(MEPS)increased significantly in both groups(P<0.05).However,the OOA group proved significantly superior to the LA group in terms of VAS and MEPS scores,as well as elbow flexion-extension ROM one month postoperatively(P<0.05),whereas which became not statistically significant between the two groups at 6 and 12 months postoperatively(P>0.05).Radiographically,the OOA group also proved significantly superior to the LA group in terms of fracture reduction quality and frac⁃ture healing time(P<0.05).[Conclusions]Compared with the LA,the OOA used for ORIF of Dubberley type II-IIIB fractures does facili⁃tate fracture reduction and has more stable internal

关 键 词：肱骨小头骨折 肘外侧入路 鹰嘴截骨入路 开放复位内固定 

分 类 号：R683.41[医药卫生—骨科学]