两种肘后入路双垂直钢板置入内固定治疗肱骨远端C型骨折

发布时间：2018-04-06 05:01

本文选题：肱骨骨折　切入点：内固定器　出处：《中国组织工程研究》2017年27期

【摘要】：背景:肱骨远端骨折常为粉碎性且解剖结构特殊,其复位及固定非常困难,何种手术入路处理此骨折更具有优势在目前临床研究中仍存在争议。目的:对比分析两种肘后入路双垂直锁定钢板内固定修复肱骨远端C型骨折的疗效。方法:将符合标准的32例肱骨远端C型骨折患者根据手术入路分为2组,尺骨鹰嘴截骨入路组18例,肱三头肌舌肌瓣入路组14例,确定2组患者在年龄、损伤机制、骨折分型等方面差异无显著性意义。对患者的手术时间、术中出血量、住院时间、愈合时间及术后随访功能及并发症的发生情况进行统计,术后1,3,6个月、1年及1年半随访。根据临床检查及影像学检查记录骨折愈合时间及并发症,术后1年采用Mayo评分评价肘关节功能。结果与结论:①尺骨鹰嘴截骨入路组患者较肱三头肌舌肌瓣入路组手术时间更长、术中出血更多(P0.05),但是预后肘关节屈曲及伸展角度更大(P0.05),术后1年肘关节功能更优(P0.05);②两入路在骨折愈合时间等方面差异无显著性意义(P0.05);③综上,肘后两种入路均能良好显露肱骨远端骨折关节面,双垂直钢板能够有效固定肱骨远端C型骨折。肱三头肌舌肌瓣入路术中损伤更小,尺骨鹰嘴截骨入路预后拥有更好的肘关节功能和更少的并发症。
[Abstract]:Background: distal humeral fractures are often comminuted and have a special anatomical structure, and their reduction and fixation are very difficult.Objective: to compare and analyze the effect of two kinds of posterior cubital fixation with double vertical locking plate for the repair of type C fracture of distal humerus.Methods: Thirty-two patients with type C fracture of distal humerus were divided into two groups according to the operative approach: 18 patients with olecranon osteotomy approach and 14 patients with lingual muscle flap approach of triceps brachii muscle. The age and injury mechanism of the two groups were determined.There was no significant difference in fracture classification.The operative time, intraoperative bleeding volume, hospitalization time, healing time, postoperative follow-up function and the occurrence of complications were analyzed. The patients were followed up for 1, 3, 6 months, 1 and 1 / 2 years after operation.The fracture healing time and complications were recorded by clinical examination and imaging examination. The elbow function was evaluated with Mayo score 1 year after operation.Results and conclusion the operative time was longer in the group of olecranon osteotomy than in the group of triceps muscle flap approach.More bleeding occurred during the operation, but the prognosis of elbow joint flexion and extension angle was greater than that of P0.05, and the function of elbow joint was better one year after operation. There was no significant difference in fracture healing time between the two approaches.The articular surface of distal humerus fracture can be well exposed by two posterior cubital approaches, and type C fracture of distal humerus can be effectively fixed with double vertical plate.The brachiocephalic muscle flap had less injury during operation and had better elbow function and fewer complications after ulnar olecranon osteotomy.
【作者单位】：大连医科大学附属第二医院创伤骨科;
【分类号】：R687.3

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