摘要
目的:比较带肘肌肌瓣尺骨鹰嘴不规则截骨入路和V形截骨入路治疗肱骨远端C3型骨折的临床疗效和安全性。方法:2013年1月至2015年11月,采用带肘肌肌瓣的尺骨鹰嘴截骨入路行双柱解剖锁定接骨板内固定治疗肱骨远端C3型骨折患者29例,15例采用尺骨鹰嘴不规则截骨(不规则截骨组)、14例采用尺骨鹰嘴V形截骨(V形截骨组)。比较2组患者的手术时间、肘关节屈伸活动范围、总体疗效及并发症发生情况。总体疗效评价采用Mayo肘关节功能评分量表。结果:所有患者均顺利完成手术,2组患者的手术时间比较,差异无统计学意义[(122.6±12.6)min,(114.6±10.3)min,t=1.711,P=0.098]。所有患者均获得随访;不规则截骨组随访11~29个月,中位数20.5个月;V形截骨组随访14~37个月,中位数24个月。不规则截骨组中术前合并尺神经损伤和桡神经损伤的患者分别于术后3个月和术后5个月恢复。不规则截骨组2例发生异位骨化;1例出现切口浅表感染,应用抗生素后治愈。V形截骨组1例发生异位骨化;1例以张力带钢丝固定尺骨鹰嘴截骨块的患者,术后1周功能锻炼时钢丝断裂,再次手术更换钢丝固定,2个月后鹰嘴截骨部位愈合。2组患者均未发生截骨部位延迟愈合或不愈合。2组患者的并发症发生率比较,差异无统计学意义(P=1.000)。末次随访时,2组患者的肘关节屈伸活动范围比较,差异无统计学意义(88.7°±11.3°,86.7°±10.8°,t=0.458,P=0.651);按照Mayo肘关节功能评分量表评定总体疗效,不规则截骨组优4例、良7例、可4例,V形截骨组优5例、良6例、可3例。2组患者的总体疗效比较,差异无统计学意义(Z=-0.516,P=0.606)。结论:经带肘肌肌瓣尺骨鹰嘴不规则截骨入路和V形截骨入路治疗肱骨远端C3型骨折的疗效和安全性相当。
Objective:To compare the clinical curative effects and safety of irregular osteotomy approach versus V-shape osteotomy approach in anconeus flap olecranon osteotomy for treatment of type C3 distal humeral fractures.Methods:Twenty-nine patients received double rods anatomical locking plate internal fixation through anconeus flap olecranon osteotomy approach for treatment of type C3 distal humeral fracture from January 2013 to November 2015.Fifteen patients were treated with irregular osteotomy of olecranon(irregular osteotomy group),while the others were treated with V-shape osteotomy of olecranon(V-shape osteotomy group).The operative times,elbow flexion-extension range,total curative effect and postoperative complications were compared between the 2 groups,and the total curative effects were evaluated by using Mayo elbow joint function scale.Results:The surgery was finished successfully in all patients and there was no statistical difference in operative time between the 2 groups(122.6+/-12.6 vs 114.6+/-10.3 min,t=1.711,P=0.098).All patients in the 2 groups were followed up.The patients in irregular osteotomy group were followed up for 11-29 months with a median of 20.5 months,and the patients in V-shape osteotomy group were followed up for 14-37 months with a median of 24 months.The patients with pre-surgery ulnar nerve injury or radial nerve injury in irregular osteotomy group recovered at 3 and 5 months after the surgery respectively.In irregular osteotomy group,the heterotopic ossifications were found in two patients and the superficial incision infection was found in one patient,who was cured after application of antibiotics.In V-shape osteotomy group,the heterotopic ossification was found in one patient and the tension band steel-wire which was fixing the olecranon bone block broke in one patient when he was taking functional exercise at 1 week after surgery,then reoperation was performed to replace the broken steel-wire,and the osteotomy site of olecranon was healed 2 months later.Neither delayed union nor nonunion of osteotomy site was found in both of the 2 groups.There was no statistical difference in complication incidences between the 2 groups(P=1.000).There was no statistical difference in elbow flexion-extension range between the 2 groups at the last follow-up(88.7+/-11.3 vs 86.7+/-10.8 degrees,t=0.458,P=0.651).The clinical comprehensive curative effects were evaluated according to Mayo elbow joint function scale.Four patients obtained an excellent result,7 good and 4 fair in irregular osteotomy group;while 5 patients obtained an excellent result,6 good and 3 fair in V-shape osteotomy group.There was no statistical difference in clinical total curative effects between the 2 groups(Z=-0.516,P=0.606).Conclusion:Irregular anconeus flap olecranon osteotomy approach and V-shape anconeus flap olecranon osteotomy approach are similar to each other in the curative effects and safty in treatment of type C3 distal humeral fractures.
作者
张川
张作君
蔡鸿敏
昌中孝
杨林平
赵明
李星星
王国杰
段小波
ZHANG Chuan;ZHANG Zuojun;CAI Hongmin;CHANG Zhongxiao;YANG Linping;ZHAO Ming;LI Xingxing;WANG Guojie;DUAN Xiaobo(Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China)
出处
《中医正骨》
2017年第12期26-30,共5页
The Journal of Traditional Chinese Orthopedics and Traumatology
基金
河南省科技攻关计划项目(152102310164)
关键词
肱骨骨折
尺骨鹰嘴
骨折固定术
内
截骨术
临床试验
humeral fractures
olecranon process
fracture fixation,internal
osteotomy
clinical tri
