改良的经肱三头肌筋膜舌形皮瓣入路治疗肱骨远端关节内骨折的临床研究

发布时间：2018-06-04 09:11

本文选题：肱骨远端 + 关节内骨折　；参考：《中国现代医学杂志》2017年13期

【摘要】：目的评价改良的经肱三头肌筋膜舌形皮瓣入路治疗肱骨远端关节内骨折的临床疗效。方法选取2012年6月-2015年4月该院收取的102例肱骨远端关节内骨折患者作为研究对象,进行前瞻性研究。将所有患者随机分为对照组和观察组,对照组51例采取经典的肱三头肌筋膜舌形皮瓣入路治疗,观察组51例采取改良的肱三头肌筋膜舌形皮瓣入路治疗。术后1、3、6和12个月对患者进行随访,行肘关节前后位、侧位X线检查,用肘关节活动范围、DASH评分(肩臂手功能障碍评分)以及肱三头肌MRC分级对肘功能进行评价。对两组患者的术后并发症进行比较。结果所有入选患者均获得12~14个月随访,平均(12.9±1.1)个月。两组患者的年龄、性别及随访时间等基本信息均无统计学意义(P0.05)。观察组患者术后3、6和12个月的DASH评分均优于对照组(P0.05)。观察组患者骨折平均愈合时间短于对照组(P0.05)。另外,末次随访时观察组患者的DASH评分、肌力评分与屈曲畸形度均优于对照组(P0.05)。术后头6个月运动范围均得到改善。所有患者均无明显并发症发生。结论针对肱骨远端关节内骨折,改良的经肱三头肌筋膜舌形皮瓣入路可为手术提供理想的可视化效果,同时使患者术后的DASH评分更高,使肘关节的运动范围更接近正常值,与经典的经肱三头肌筋膜舌形皮瓣入路相比具有更好的临床价值,值得进一步推广应用。
[Abstract]:Objective to evaluate the clinical effect of modified transtriceps fasciocutaneous flap approach in the treatment of distal humeral fractures. Methods 102 patients with intraarticular fractures of distal humerus received from June 2012 to April 2015 were selected for prospective study. All the patients were randomly divided into control group and observation group. 51 cases in control group were treated by classic triceps fascia tongue flap approach, 51 cases in observation group were treated by modified triceps fascia tongue flap approach. The patients were followed up for 6 and 12 months after operation. The elbow function was evaluated by X-ray examination of the anterior and posterior position of elbow joint and lateral position. The elbow function was evaluated with the range of motion of elbow joint and the score of shoulder, arm and hand dysfunction, as well as the MRC grade of triceps brachii muscle. The postoperative complications were compared between the two groups. Results all patients were followed up for 12 ~ 14 months with an average of 12.9 卤1.1 months. There was no significant difference in age, sex and follow-up time between the two groups (P 0.05). The DASH scores of the patients in the observation group were better than those in the control group at 3 and 12 months postoperatively (P 0.05). The average healing time of fracture in the observation group was shorter than that in the control group (P 0.05). In addition, the DASH score, muscle strength score and flexion deformity in the observation group were better than those in the control group at the last follow-up (P 0.05). The range of exercise was improved in the first 6 months after operation. No significant complications occurred in all patients. Conclusion for intra-articular fractures of distal humerus, the modified transtriceps fasciocutaneous flap approach can provide an ideal visual effect for the operation, at the same time, the DASH score of the patients after operation is higher, and the range of motion of the elbow joint is closer to the normal value. Compared with the classic transtriceps fasciocutaneous flap approach, it has better clinical value and deserves further application.
【作者单位】：陕西省榆林市中医医院骨科;
【分类号】：R687.3

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