尺骨鹰嘴截骨入路结合双侧锁定板治疗肱骨远端C3型骨折的临床研究

摘要

Objective To compare the clinical effect of olecranon osteotomy approach combined with bilateral locking plate and bilateral approach of triceps brachii in the treatment of C3 distal humerus fractures.Methods We retrospectively analyzed 45 cases of C3 distal humeral fractures who underwent surgical treatment from July 2006 to February 2016.Twenty-five patients underwent olecranon osteotomy with bilateral locking plate surgery, there were 14 males and 11 females with a mean age of (56.3±4.2) years and hospital stay (15.6±1.7 days).Twenty patients underwent transthoracic approach with double-plate operation, 11 males and 9 females, age (53.8±5.1) years, mean hospital stay (17.8±2.2) days.The two treatment methods were compared and analyzed from three aspects: the operation related index, the postoperative complication condition and the ipsilateral elbow joint function score.Results 45 patients were followed up for 12~38 months (mean 19.6 months).1 case of infection, 3 cases of heterotopic ossification, 1 case of nonunion, 1 case of elbow joint activity is limited.There was no significant difference in the length of the incision between the two groups (P<0.05), but there was no significant difference in the operation time, hospitalization time and fracture healing time (P>0.05).There was no significant difference in the incidence of postoperative complications (P>0.05).There was significant difference in elbow joint function of the Mayo Score System (MEPS) at the last follow-up (P<0.05).Conclusions Ulnar olecranon osteotomy approach combined with bilateral locking plate fixation of distal humerus C3 fracture has a clear surgical manifestation, trauma is relatively small, functional recovery is good, and has a strong internal fixation, early functional exercise, which is one of the ideal way for the treatment of distal humeral fractures of the C3 type of surgery.%目的 对比分析尺骨鹰嘴截骨入路结合双侧锁定板与肱三头肌两侧入路结合双钢板治疗肱骨远端C3型骨折临床效果.方法 对2006年7月至2016年2月进行手术治疗并获得随访的45例肱骨远端C3型骨折患者进行回顾性分析,其中25例行尺骨鹰嘴截骨入路结合双侧锁定板手术治疗,男14例,女11例,年龄(56.3±4.2)岁,住院时间(15.6±1.7)d;20例行肱三头肌两侧入路结合双钢板手术治疗,男11例,女9例,年龄(53.8±5.1)岁,平均住院时间(17.8±2.2)d.从手术相关指标、术后并发症情况及患侧肘关节功能评分3个方面对两种治疗方法进行比较分析.结果 45例患者均获得随访,时间12~38个月,平均19.6个月.1例感染,3例出现异位骨化,1例骨折不愈合,1例肘关节活动受限.两组切口长度比较差异有统计学意义(P<0.05),而手术时间、住院时间、骨折愈合时间比较差异无统计学意义(P>0.05).术后并发症的发生率比较差异无统计学意义(P>0.05),末次随访的Mayo评分系统(MEPS)肘关节功能比较差异有统计学意义(P<0.05).结论 尺骨鹰嘴截骨入路结合双侧锁定板内固定治疗肱骨远端C3型骨折具有关节面骨折显露清晰、创伤相对较小、功能恢复好等特点,且具有内固定坚强、可以早期功能锻炼等优点,是治疗肱骨远端C3型骨折的理想手术方式之一.