肱骨远端C型骨折的手术方式选择

Surgical Options Choices for the Distal Humerus Type C Fractures

摘要: 目的：比较肱骨远端C型骨折2种不同手术方式的疗效和适应症。方法：分别采用2种手术方式治疗肱骨远端C型骨折56例，男34例，女22例，年龄20~64岁，平均40.1岁。其中尺骨鹰嘴截骨组(A组) 30例，肱三头肌两侧联合入路组(B组) 26例。结果：入选病例均获随访11~36个月，平均15个月。两组均未发生骨不连、内固定断裂、关节腔感染、迟发型尺神经炎、肘关节僵硬等并发症。骨折愈合时间为12~24周，A组平均为17.6周，B组平均18.4周(P > 0．05)。A组手术时间、X线暴露时间明显少于B组(P < 0.05)。肘关节功能根据改良Cassebaum法进行评分。A组与B组优良率分别为80.0%和80.8% (P > 0.05)；两组内的优良率均随着骨折复杂程度的提高(C1型~C3型)分别呈现递减趋势(P < 0.05)。其中A组波动幅度较小，说明尺骨鹰嘴截骨入路治疗肱骨髁间骨折的优良率更为稳定。结论：我们推荐C1型和C2型一般患者采用经肱三头肌双侧联合入路；C3型骨折和C2型肥胖或肌肉发达的患者采用尺骨鹰嘴截骨入路。这两种入路根据骨折分型和术中情况灵活变化，能满足肱骨远端各种类型骨折复位固定的需要。

Abstract: Objective: To compare the efficacy and indication of the two operative treatments of type C in-tercondylar fractures of the distal humerus. Methods: Reviewing the clinical data of 56 cases used two operative treatments of types C intercondylar fractures of the distal humerus during May 2010 to Oct. 2015. These cases including 34 males and 22 females with an average age of 40.1-year-old ranging from age 20 - 64 years were divided into 2 groups: olecranon osteotomy approaches group (A-Group,30 cases); triceps-sparing approaches group (B-Group,26 cases). Results: All cases were follow-up for 11 to 36 months (average 15 months) and obtained flint intention incisions healing and satisfied replacement without complications such as fracture nonunion, implant rupture, articular cavity infection, late-onset ulnar neuritis, elbow stiffening. Fracture healing time was 12 - 24 weeks, the A-Group in average 17.6 weeks and the B-Group in average 18.4 weeks, between the two groups showed no significant difference (P > 0.05). Post-operative elbow function scoring according to Cassebaum scoring system, A-Group: excellent in 16 cases, better in 8 cases, good in 5 cases and poor in 1 case, fine rate was 80.0%. B-Group: ex-cellent in 14 cases, better in 7 cases, good in 4 cases and poor in 1 case, fine rate was 80.8%. Difference between the two groups was not statistically significant (P > 0.05). The excellent rate of the two groups showed a trend of decreasing, respectively, with the increase of complexity of fracture (C1-C3), in which A-group of less volatility indicated that the olecranon osteotomy ap-proach was more stable. Conclusion: We recommend that the C1 and C2 type operation with bi-lateral triceps approaches, C3 and the obese or muscular of C2 type operation with Ulna Olec-ranon Osteotomy. The two approaches are flexible in the fractal and intraoperative condition, which can meet the need for the fixation of various types C intercondylar fractures of the distal humerus.