经肱三头肌两侧入路双钢板内固定治疗肱骨远端骨折  

Double plates internal fixation via bilateral triceps approaches in the treatment of distal humeral fractures

作　　者：吴青松 赵磊 林治建 王飞 WU Qing-song;ZHAO Lei;LIN Zhi-jian;WANG Fei(Dept of Limb Trauma,Shandong Wendeng Orthopaedic Hospital,Weihai,Shandong 264400,China)

机构地区：[1]山东省文登整骨医院四肢创伤科,山东威海264400

出　　处：《临床骨科杂志》2023年第4期547-551,共5页Journal of Clinical Orthopaedics

摘　　要：目的探讨经肱三头肌两侧入路双钢板内固定治疗肱骨远端骨折的疗效。方法采用经肱三头肌两侧入路双钢板内固定治疗33例骨质疏松性C3型肱骨远端骨折患者。记录手术情况、骨折愈合时间、肘关节及前臂活动度以及术后并发症发生情况,末次随访时采用MEPS评分评价功能恢复情况。结果患者均获得随访,时间8~15个月。手术时间80~120(93.5±11.6)min。术后3~8个月X线片显示骨折内固定位置良好,骨折线模糊,可见连续性骨痂通过骨折线,提示骨折均愈合。术后无内固定松动或断裂、骨折复位丢失、骨折畸形愈合以及尺神经炎等并发症发生,4例发生骨化性肌炎。末次随访时,肘关节活动度:屈曲100°~140°,伸直5°~30°;前臂旋转活动度:旋前60°~80°,旋后55°~75°;肘关节MEPS评分为55~95分,其中优10例,良16例,可3例,差4例,优良率78.8%(26/33)。结论经肱三头肌两侧入路能够为骨质疏松性C3型肱骨远端骨折双钢板固定提供良好的手术显露,避免尺骨鹰嘴截骨所带来的二次损伤,术后患者能够获得良好的肘关节功能。Objective To investigate the effect of double plates internal fixation on distal humerus fracture with bilateral triceps approaches.Methods The 33 patients with osteoporotic type C3 fractures of distal humerus were treated with double plates with bilateral triceps approaches.Surgery situation,fracture healing time,range of motion of the elbow and forearm,and postoperative complications were recorded.At the last follow-up,Mayo elbow performance score(MEPS)was used to evaluate the elbow functional recovery.Results All patients were followed up for 8~15 months.The operation time was 80~120(93.5±11.6)min.At 3~8 months after surgery,X-ray radiographs showed that there were good position of internal fixation,with blurred fracture lines and continuous callus passing through the fracture lines,it suggested that all fractures healed.There were no complications such as internal fixation loosening or fracture,loss of fracture reduction,malunion and ulnar neuritis;4 cases developed myositis ossificans.At the last follow-up,elbow range of motion was flexion with 100°~140°,extension with 5°~30°.Rotation range of forearm:pronation 60°~80°,supination 55°~75°.The MEPS of the elbow joint was 55~95 points,of which 10 cases were excellent,16 cases were good,3 cases fair,and 4 poor,with an excellent-good rate of 78.8%(26/33).Conclusions The bilateral triceps approaches can provide good surgical exposure for osteoporotic type C3 distal humerus fractures with double plates fixation,which avoid secondary injury caused by olecranon osteotomy,and the patients can obtain good elbow function after surgery.

关 键 词：肱骨远端骨折 骨质疏松 肱三头肌入路 双钢板内固定 

分 类 号：R683.41[医药卫生—骨科学] R681[医药卫生—外科学] R687.32[医药卫生—临床医学]