目的:探讨肱骨髁间骨折行切开复位内固定术中尺神经前置与不前置处理对肘关节活动度、功能及术后尺神经功能障碍的影响.方法:自2013年1月至2017年5月,采用切开复位内固定术治疗并获得完整随访的168例肱骨髁间骨折患者,根据术中对尺神经的处理方式将患者分为尺神经前置组和尺神经不前置组.尺神经前置组48例,男23例,女25例;年龄14～77(42.5±15.7)岁;在肱骨髁间骨折复位结束后,对尺神经进行充分游离并行皮下前置术.尺神经不前置组120例,男62例,女58例;年龄14～81(43.4±17.3)岁;在肱骨髁间复位结束后,将尺神经返回尺神经沟.末次随访时记录两组患者肘关节屈伸活动范围及前臂旋转活动范围,采用Mayo肘关节功能评分(Mayo elbow performance score,MEPS)对患者的临床疗效进行评价,采用改良McGowan分级评分对尺神经功能障碍进行评估.结果:尺神经前置组1例鹰嘴截骨处延迟愈合,2例肘关节僵硬;尺神经不前置组1例伤口感染,1例骨折不愈合,4例肘关节僵硬.两组并发症发生情况比较差异无统计学意义(P>0.05).尺神经前置组48例获得随访,时间12～59(32.2± 14.2)个月,肘关节屈伸活动范围(116±28)°,前臂旋转活动范围(152±12)°,MEPS评分88.6±11.6,优28例,良16例,中3例,差1例;术后17例曾出现过尺神经损伤症状,末次随访时仍有7例存在尺神经功能障碍,McGowan 1级6例, 2级1例.尺神经不前置组120例获得随访,时间13～61(32.0±14.9)个月,肘关节屈伸活动度(119±27)°,前臂旋转活动度(154±16)°,MEPS评分88.9±12.5,优67例,良44例,中7例,差2例;术后42例曾出现过尺神经损伤症状,末次随访时仍有22例存在尺神经功能障碍,McGowan 1级18例,2级4例.两组患者随访时间、肘关节屈伸活动范围、前臂旋转活动范困、MEPS评分及尺神经功能障碍发生情况比较差异均无统计学意义(P>0.05).结论:肱骨髁间骨折切开复位内固定术中对尺神经前置或不前置,对术后临床疗效及尺神经功能障碍发生情况无明确影响.%Objective:To compare activity,function and postoperative ulnar nerve function of elbow joint by anterior transposition of ulnar nerve or not during open reduction and internal fixation for intercondylar humerus fractures. Methods:From January 2013 to May 2017,168 patients with intercondylar humerus fractures were treated surgically with open reduction and internal fixation (ORIF). The patients were divided into anterior subcutaneous transposition group and simple decompression group according to handling method of ulnar nerve. There were 48 patients in transposition group, including 23 males and 25 females with an average age of (42.5±15.7) years old ranging from 14 to 77 years old,and ulnar nerve treated enough free and anterior subcutaneous transpostion after reduction of intercondylar humerus fractures; while there were 120 patients in simple decompression group, including 62 males and 58 females with an average age of (43.4±17.3) years old ranging from 14 to 81 years old,ulnar nerve returned to sulci nervi ulnaris. Activity of flexion and extension of elbow joint, range of rotation of forearm were recorded at the latest following-up,Mayo score of elbow joint was used to evaluate clinical effect, McGowan grading was used to assess dysfunction of unlnar nerve. Results:There was 1 patient delayed union,and 2 patients occurred joint stiffness in transposition group;while 1 patient suffered from incision infection, 1 fracture nonunion,and 4 joint stiffness in simple decompression group;and there was no statistical difference between two groups(P>0.05). Forty-eight patients in transposition group were followed-up from 12 to 59 months with an average of (32.2±14.2) months, activity of flexion and extension of elbow joint was (116±28)°, range of rotation of forearm was (152±12)°,MEPS score was 88.6±11.6;and 28 patients got ex-cellent results, 16 good, 3 moderate and 1 poor. There were 17 patients occurred injury of ulnar nerve, and 7 patients still occurred dysfunction of ulnar nerve, and 6 patients were grade I,1 patient was grade Ⅱ according to McGowan grading. In simple decompression group, there were 120 patients were followed-up from 13 to 61 months with an average of (32.0±14.9) months, activity of flexion and extension of elbow joint was (119±27)°,range of rotation of forearm was (154±16)°,MEPS score was 88.9土 12.5;and 67 patients got excellent results,44 good,7 moderate and 2 poor. There were 42 patients occurred injury of ulnar nerve,and 22 patients still occurred dysfunction of ulnar nerve,and 18 patients were grade I,4 patients were grade Ⅱ according to McGowan grading. There were no statistical differences in following time, activity of flexion and extension of elbow joint,range of rotation of forearm,MEPS score and dysfunction of ulnar nerve. Conclusion:Whether anterior transposition of ulnar nerve or not has no clarified effects for open reduction and internal fixation for intercondylar humerus fractures.
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