不同入路方式垂直钢板内固定治疗成人肱骨远端C型骨折的临床疗效  

Effect of Vertical Plate Internal Fixation with Different Approaches on Type C Fractures of Distal Humerus in Adults

作　　者：杜江[1] 胡兆兴 朱齐飞[1] DU Jiang;HU Zhaoxing;ZHU Qifei(Department of Orthopedics,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)

机构地区：[1]南京医科大学第二附属医院骨科,南京210011

出　　处：《医学综述》2023年第8期1651-1655,共5页Medical Recapitulate

摘　　要：目的分析不同入路方式垂直钢板内固定术治疗成人肱骨远端C型骨折的临床疗效。方法选取2015年7月至2019年7月南京医科大学第二附属医院收治的79例成人肱骨远端C型骨折患者,均行外科手术治疗。根据手术中的不同入路方式分为截骨组(38例)和两侧组(41例)。其中,截骨组采用经尺骨鹰嘴截骨入路,两侧组采用经肱三头肌两侧入路。比较两组围手术期指标(手术时间、术中出血量、术后切口引流量、骨愈合时间),血清骨代谢指标[骨钙素、骨碱性磷酸酶(BALP)、总Ⅰ型前胶原氨基端延长肽(T-P1NP)]、关节活动度(ROM)、肘关节功能变化及并发症发生率。结果两侧组患者的手术时间短于截骨组[(84±64)min比(115±12)min](P<0.01),术中出血量、术后切口引流量少于截骨组[(153±21)ml比(190±32)ml、(78±20)ml比(111±22)ml](P<0.01)。骨钙素、BALP、T-P1NP水平时点间与组间的主效应差异有统计学意义(P<0.01),时点间与组间存在交互作用(P<0.01)。出院时,两组患者的骨钙素水平均较术后1 d升高,且两侧组高于截骨组(P<0.05);BALP、T-P1NP水平较术后1 d降低,且两侧组低于截骨组(P<0.05)。随访3个月时,两侧组患者的屈曲度、旋前度、旋后度均大于截骨组[(144.78±9.17)°比(130.90±9.98)°、(86.91±0.91)°比(77.91±1.12)°、(83.02±1.29)°比(75.28±1.07)°](均P<0.01)。两组患者的总优良率、总并发症发生率比较差异均无统计学意义(P>0.05)。结论经肱三头肌两侧入路暴露骨折端及关节面的效果略差于经尺骨鹰嘴截骨入路,适用于C1型、C2型骨折;经尺骨鹰嘴截骨入路可更加充分暴露骨折端及关节面,适用于C3型骨折,临床可根据患者实际情况灵活应用入路方式。Objective To analyze the clinical effect of vertical plate internal fixation with different approaches for treating type C fractures of distal humerus in adults.Methods A total of 79 adult patients with C-type distal humeral fractures treated in the Second Affiliated Hospital of Nanjing Medical University from Jul.2015 to Jul.2019 were included,and all of them underwent surgical treatment.According to different approaches in the operation,they were divided into an osteotomy group(38 cases)and a bilateral group(41 cases).The osteotomy group adopted the transulnar olecranon osteotomy approach,and the bilateral group adopted the bilateral approach through triceps brachii.Perioperative indicators(operation time,intraoperative blood loss,postoperative incision drainage,bone healing time),serum bone metabolism indicators[osteocalcin,bone alkaline phosphatase(BALP),total typeⅠprocollagen N-terminal extension peptide(T-P1NP)],joint range of motion(ROM),elbow joint function changes and complication rate were compared between the two groups.Results The operation time in the bilateral group was shorter than that in the osteotomy group[(84±64)min vs(115±12)min](P<0.01),and the amount of intraoperative blood loss and postoperative incision drainage were less than those in the osteotomy group[(153±21)ml vs(190±32)ml,(78±20)ml vs(111±22)ml](P<0.01).The main effect differences of osteocalcin,BALP and T-P1NP levels between time points and groups were statistically significant(P<0.01),and there were interactions between time points and groups(P<0.01).At discharge,the level of osteocalcin in both groups was higher than those on the 1st day after operation,and the bilateral group higher than the osteotomy group(P<0.05);the levels of BALP and T-P1NP were lower than that on the 1st day after operation,and the bilateral group lower than the osteotomy group(P<0.05).After 3 months follow-up,the flexion,pronation and supination of the bilateral group were greater than those in the osteotomy group[(144.78±9.17)°vs(130.90±9.98)°

关 键 词：肱骨远端C型骨折 肱三头肌两侧入路 尺骨鹰嘴截骨入路 血清骨代谢 肘关节功能 骨钙素 

分 类 号：R683.41[医药卫生—骨科学]