肘关节外侧入路微型钢板内固定治疗Dubberley 3B型肱骨远端冠状面骨折  

Clinical efficacy of mini plate internal fixation through lateral elbow joint approach for Dubberley 3B distal humeral coronal fractures

作　　者：王庆伟 王华松 石华峰 胡寿勇 周奇煌 王军海 Wang Qingwei;Wang Huasong;Shi Huafeng;Hu Shouyong;Zhou Qihuang;Wang Junhai(Department of Orthopaedics,Jinmen Central Hospital,Jinmen 448000,China;Department of Orthopedics,General Hospital of PLA Central Theater,Wuhan 430070,China;Department of Medical,Jingmen Vocational College,Jinmen 448000,China)

机构地区：[1]荆门市中心医院,荆门448000 [2]解放军中部战区总医院,武汉430070 [3]荆门职业学院,荆门448000

出　　处：《中华骨科杂志》2024年第23期1532-1540,共9页Chinese Journal of Orthopaedics

基　　金：2023年度湖北省教育厅科研计划项目(B2023220);荆门市重点科技计划项目(2022YFZD018,2024YFZD054);荆门市科协资助课题(202424)。

摘　　要：目的比较采用肘关节外侧入路微型钢板内固定与后方鹰嘴截骨入路内固定治疗Dubberley 3B型肱骨远端冠状面骨折的临床疗效。方法回顾性分析2018年1月至2023年5月荆门市中心医院骨科(15例)和解放军中部战区总医院骨科(20例)诊治的35例Dubberley 3B型肱骨远端冠状面骨折患者资料,男24例,女11例;年龄32~64岁;左侧18例,右侧17例。采用肘关节外侧入路微型钢板内固定治疗23例(外侧入路组),常规后方鹰嘴截骨入路内固定治疗12例(后方入路组)。记录并比较两组的手术切口长度、手术时间、术中出血量、住院时间、骨折愈合情况及并发症发生情况。术后1周、1个月采用视觉模拟评分(visual analogue scale,VAS)评价疼痛程度,术后3个月及末次随访时采用Mayo肘关节功能评分(Mayo elbow performance score,MEPS)评定肘关节功能恢复情况。结果外侧入路组与后方入路组患者术前基线资料比较差异均无统计学意义(P>0.05),外侧入路组患者随访(18.7±3.9)个月(范围12~47个月),后方入路组患者随访(22.3±4.7)个月(范围12~52个月)。外侧入路组的手术切口长度为(10.5±0.9)cm、手术时间为(76.3±4.7)ml、术中出血量为(65.6±10.2)ml、住院时间为(10.4±1.5)d、骨折愈合时间为(4.2±0.9)个月,均小于后方入路组的(21.2±1.7)cm、(98.8±6.1)min、(148.5±14.9)ml、(15.8±1.6)d、(5.7±1.1)个月,差异有统计学意义(P<0.05)。术后1周、1个月外侧入路组VAS[(2.7±0.4)、(1.3±0.4)分]均低于后方入路组[(3.1±0.5)、(1.8±0.6)分],差异有统计学意义(t=2.577,P=0.015;t=2.288,P=0.029);术后3个月外侧入路组MEPS为(83.6±1.7)分,高于后方入路组的(60.3±4.2)分,差异有统计学意义(t=23.418,P<0.001)。随访期间两组VAS均呈降低趋势、MEPS均呈增加趋势,末次随访时两组MEPS的差异无统计学意义(P>0.05)。至末次随访,外侧入路组3例发生关节退变,未见神经、血管损伤、螺钉切割、骨折不愈合�ObjectiveTo compare the clinical efficacy of using micro steel plate internal fixation through the lateral elbow joint approach and traditional posterior olecranon osteotomy approach for the treatment of Dubberley 3B distal humeral coronal fracture.MethodA retrospective analysis was conducted on the data of 35 patients with Dubberley 3B distal humeral coronal fractures admitted to the Orthopedics Department of Jingmen Central Hospital(15 cases)and the Central Theater Command General Hospital of the People's Liberation Army(20 cases)from January 2018 to May 2023.Among them,23 cases were treated with micro steel plate internal fixation through the lateral elbow joint approach(study group),and 12 cases were treated with traditional posterior olecranon osteotomy approach internal fixation(control group).There were 24 males and 11 females aging from 32 to 64 years old with 18 left elbows and 17 right ones.All of them were fresh fracture cases.The surgical incision length,surgical time,intraoperative bleeding,hospital stay,fracture healing,and incidence of complications between the two groups were recorded and compared.Visual analog scale(VAS)was recorded at 1 week and 1 month after surgery.Function recovery was assessed using Mayo elbow joint function score(Mayo elbow performance score,MEPS)at 3 months and the last follow-up.ResultThere was no significant difference in preoperative baseline data between the study group and control group(P>0.05).Patients in the study group were followed up for 18.7±3.9 months(range 12-47 months)while those in the control group were followed up for 22.3±4.7 months(range 12-52 months).There were significant differences between the study group and control group in the surgical incision length(10.5±0.9 cm vs.21.2±1.7 cm),surgical time(76.3±4.7 min vs.98.8±6.1 min),intraoperative blood loss(65.6±10.2 vs.148.5±14.9 ml),length of stay(10.4±1.5 vs.15.8±1.6 d),and fracture healing time(4.2±0.9 months vs.5.7±1.1 months)(P<0.05).At the follow-up of 1 week and 1 month,the VAS of the st

关 键 词：肱骨骨折 骨折固定术 内 肘关节 Dubberley分型 

分 类 号：R687.3[医药卫生—骨科学]