前外侧入路结合Kocher入路治疗肱骨远端冠状面骨折

发布时间：2018-11-13 09:53

【摘要】：目的探讨前外侧入路结合Kocher入路治疗肱骨远端冠状面骨折的疗效。方法回顾性分析2008年3月—2014年2月由浙江大学医学院附属第二医院收治的肱骨远端冠状面骨折患者14例,按Dubberley分型:2A型7例,2B型1例,3A型4例,3B型2例。所有患者均采用前外侧入路结合Kocher入路,术中以Bold螺钉固定。常规于术后第1、2、3、6、9、12、18个月进行随访,根据患者X线摄片观察骨折愈合情况,根据Mayo肘关节功能评分标准进行肘关节功能评分,于上肢处于中立位时测定肘关节活动度(屈肘和伸肘的角度)。结果所有患者均顺利完成手术,术后第2天即可进行辅助性主动功能锻炼。本组14例患者中有2例失访,余均获随访。随访时间10~22个月,中位随访时间为14.2个月。Mayo肘关节功能评分55~100分,中位肘关节功能评分为87.5分。肘关节活动度:伸肘角度0~22°,中位伸肘角度为8°;屈肘角度95~135°,中位屈肘角度为122°。所有患者术中骨折均解剖复位后固定,术后均为骨性愈合,愈合时间为术后10~16周,中位愈合时间为术后11.4周。术后无1例患者发生伤口感染和血管、神经损伤,1例患者发生创伤性关节炎,3例发生异位骨化。结论前外侧入路结合Kocher入路治疗肱骨远端冠状面骨折,有利于术中解剖复位、坚强固定,术后早期患者即可进行功能锻炼。
[Abstract]:Objective to evaluate the efficacy of anterolateral approach combined with Kocher approach in the treatment of distal humeral coronal fractures. Methods from March 2008 to February 2014, 14 patients with distal coronal fracture of humerus treated by the second affiliated Hospital of Zhejiang University Medical College were retrospectively analyzed. According to Dubberley classification, there were 7 cases of type 2A, 1 case of type 2B, 4 cases of type 3A and 2 cases of type 3B. All patients were treated with anterolateral approach combined with Kocher approach and fixed with Bold screw during operation. The patients were followed up for 18 months. The fracture healing was observed by X-ray, and the function of elbow joint was scored according to Mayo elbow function scoring standard. The elbow motion (the angle of elbow flexion and extension) was measured when the upper limb was in neutral position. Results all the patients completed the operation successfully, and on the second day after operation, auxiliary active function exercise was performed. Of the 14 cases, 2 cases lost their visits and the rest were followed up. The median follow-up time was 14.2 months. The Mayo elbow function score was 55 ~ 100 and the median elbow function score was 87.5. The range of motion of elbow joint: the angle of elbow extension was 22 掳, the angle of elbow extension was 8 掳, the angle of elbow flexion was 95 掳and 135 掳, and the angle of elbow flexion was 122 掳. All the patients were fixed after anatomic reduction and fixation. The healing time was 1016 weeks and the median healing time was 11.4 weeks. There was no wound infection, vascular and nerve injury in 1 case, traumatic arthritis in 1 case, ectopic ossification in 3 cases. Conclusion anterolateral approach combined with Kocher approach for the treatment of distal humeral coronal fracture is beneficial to anatomical reduction and firm fixation during operation and early postoperative functional exercise.
【作者单位】：浙江大学医学院附属第二医院骨科;武警浙江省总队嘉兴医院骨四科;
【分类号】：R687.3

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