两种手术入路治疗肱骨远端冠状面剪切骨折的临床效果

发布时间：2019-06-21 08:28

【摘要】：目的:比较前外侧入路及外侧入路切开复位内固定治疗肱骨远端冠状面剪切骨折的效果,探讨两种手术方法的利弊及适应证。方法:回顾性分析北京积水潭医院2006年9月至2014年7月的10例肱骨远端冠状面剪切骨折的切开复位内固定病例,以Dubberley方法进行骨折的分型,采用前外侧入路为A组,外侧入路为B组,记录术后并发症发生情况,Mayo评分评价最终临床结果。结果:A组5例,术前分型ⅠA型1例,ⅡA型1例,ⅢA型1例,ⅢB型2例,均用自前向后埋头螺钉固定骨折块,对滑车桡侧骨折块也以螺钉单独固定,术后Mayo评分平均82分,4例需再次手术,2例因螺钉刺激行内固定物取出,1例肘关节僵硬,1例内固定失效,1例发生一过性桡神经损伤;B组5例,术前分型ⅠA型和ⅠB型各1例,ⅡA型3例,术后Mayo评分平均91分,仅1例发生内固定失效,肘关节不稳定需再次手术。结论:外侧入路较好,但对滑车部位骨折的处理略显不足,术中要注意外侧副韧带(lateral collateral ligament,LCL)的保护及修复。前外侧入路并发症发生较多,优点是对滑车部位的显露较直接,但因不脱位,肘关节显露范围较小,对于肱骨远端的压缩骨折显露及固定欠佳。
[Abstract]:Objective: to compare the effect of anterior lateral approach and lateral approach open reduction and internal fixation in the treatment of coronal shear fracture of distal humerus, and to explore the advantages, disadvantages and indications of the two surgical methods. Methods: from September 2006 to July 2014 in Beijing Jishuitan Hospital, 10 cases of distal humerus coronal shear fracture were treated with open reduction and internal fixation. Dubberley method was used to classify the fracture. The anterior lateral approach was used as group A and the lateral approach was used as group B. the postoperative complications were recorded and the final clinical results were evaluated by Mayo score. Results: in group A, there were 1 case of preoperative classification, 1 case of type 鈪，

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