经肱三头肌劈开入路治疗C型肱骨远端骨折的疗效分析

目的 探讨经肱三头肌劈开入路内固定治疗C型肱骨远端骨折的疗效。方法 回顾分析2011年1月至2013年1月期间收治的43例C型肱骨远端骨折(C1型17例,C2型15例,C3型11例),均为闭合性新鲜骨折,对该型骨折均采取经肱三头肌劈开入路“Y”形钢板或双重建钢板内固定治疗。所有患者在取出内固定前均采用Mayo肘关节功能评分标准(MEPS)进行临床疗效评定。结果 本组43例患者中40例切口Ⅰ/甲愈合,余3例经换药及抗感染治疗,均延迟愈合。所有患者均获得随访,随访时间24.0~36.0个月,平均(29.5±4.3)个月,无骨不愈合及内固定断裂等并发症的发生。MEPS评分结果:优18例,良20例,中3例,差2例,优良率:88.4%。结论 经肱三头肌劈开入路治疗C型肱骨远端骨折,入路简单、创伤小、保存了伸肘装置,且能满足对骨折关节面的有效显露,内固定物安放方便、合理有效,临床疗效好,可作为治疗C型肱骨远端骨折的手术入路之一。

Clinical effectiveness of triceps-splitting approach in the treatment of type C fractures of distal humerus

Objective To investigate the clinical effectiveness of triceps-splitting approach in the treatment of type C fractures of distal humerus. Methods Clinical data of 43 patients with type C closed fresh fractures of distal humerus (17 cases of type C1, 15 cases of type C2, and 11 cases of type C3) during Jan. 2011 to Jan. 2013 were collected retrospectively. All patients were treated by Y-shaped plate or double plate internal fixation via the triceps-splitting approach. Mayo elbow performance score (MEPS) system was used to evaluate the treatment outcome. Results Among 43 cases, 40 cases obtained primary healing of the incisions, and 3 cases had mild needle infection, which was cured after dressing change and antibiotic treatment. All cases were followed up for 24.0-36.0 months (mean 29.5±4.3 months). No non- union, breaking of internal fixators or other complications occurred. The curative effectiveness was excellent in 18 cases, good in 20 cases, fair in 3 cases and poor in 2 cases according to MEPS, with the satisfactory rate being 88.4%. Conclusion The triceps-splitting approach is an available technology with less injury and without invasion to the cubital extension mechanism. It is indicated that it is simple, safe and reliable to treat type C fractures of distal humerus.