经尺骨鹰嘴截骨入路与肱三头肌舌状瓣入路治疗肱骨髁间骨折的对比研究

目的对比经尺骨鹰嘴截骨入路与经肱三头肌舌状瓣入路治疗肱骨髁间骨折的临床效果。方法 2002年5月至2009年2月,手术切开复位内固定治疗62例肱骨髁间骨折患者。其中33例采用尺骨鹰嘴入路。按Riseborough-Radin分型,Ⅲ型18例,Ⅳ型15例。29例采用肱三头肌舌状瓣入路。左侧16例,右侧13例。按Riseborough-Radin分型,Ⅲ型18例,Ⅳ型11例。比较两组手术时间、出血量、术后并发症及愈合时间等,用Mayo评分来评价术后肘关节功能的改善程度。结果术后随访12～36个月,平均16.7个月。所有患者切口均Ⅰ期愈合。手术时间、出血量及愈合时间两组比较差异无统计学意义。术后尺骨鹰嘴截骨入路组肘部疼痛发生率低于肱三头肌舌状瓣入路组,肘关节活动度。采用尺骨鹰嘴入路组（优良率为87.88%）优于采用肱三头肌舌状瓣入路组（优良率为65.51%）。结论采用尺骨鹰嘴入路组的术后并发症的发生率少于采用肱三头肌舌状瓣入路组,术后肘关节活动度的满意率高于采用肱三头肌舌状瓣入路组采用肱三头肌舌状瓣入路组。

Osteotomy of olecranon and triceps tongue-shaped flap approach in treatment of humeral intercondylar fractures: a comparative study

Objective To compare the osteotomy of olecranon and the triceps tongue-shaped flap approach in treatment of intercondylar humeral fractures.Methods From May 1998 to February 2008,There were 62 cases of humeral intercondylar fracture patients treated with operation of open reduction and internal fixation.33 patients were treated with olecranon approach.According to Riseborough-Radin classification,there were 18 cases of type Ⅲ,15 cases of type Ⅳ.In 29 patients treated with tongue-shaped flap approach,there were 18 cases of type Ⅲ,11 cases of type Ⅳ.The operation time,bleeding volume,postoperative complications and healing time were compared between two groups.Mayo score was applied to evaluate the postoperative improvement of elbow joint function.Results All cases were followed up for 12~36 months,meanly 16.7 months.All patients’ incisions healed in one stage.There were no significant differences between the two groups in the operation time,bleeding volume and healing time.The elbow pain incidence of postoperative ulnar olecranon osteotomy approach group was lower than that of the triceps tongue-shaped flap approach group.The elbow motion of postoperative ulnar olecranon osteotomy approach group(Excellent and good rate: 87.88%) was better than that of the triceps tongue-shaped flap approach group(Excellent and good rate: 65.51%).Conclusion The postoperative complication rate of the olecranon approach group is less than that of the triceps tongue-shaped flap approach group,while the postoperative elbow joint activity satisfaction rate of the olecranon approach group is higher than that of the triceps tongue-shaped flap approach group.