两种手术入路治疗老年肱骨髁间骨折的疗效分析

目的比较采用尺骨鹰嘴截骨和肱三头肌切开两种不同入路双钢板内固定治疗老年肱骨髁间骨折的疗效。方法对2005年7月至2009年1月收治的47例分别采用尺骨鹰嘴截骨和肱三头肌切开两种不同入路治疗的老年肱骨髁间骨折患者资料进行回顾性分析,观察比较两组患者:①住院时间,骨折愈合时间;②术后3个月肘关节主动屈伸活动范围;③术后3个月肘关节功能采用MEPS肘关节功能评分系统(Mayo elbow performance score,MEPS)进行评定。结果所有患者平均随访(12±2.3)个月。所有患者切口均Ⅰ期愈合,无切口感染及深部感染,无尺神经损伤。两组平均住院时间分别为(17±3.5)天和(18±3.0)天,无统计学意义(P>0.05)。两组骨折愈合时间分别为(7±1.5)周和(7±1.3)周,无统计学意义(P>0.05)。术后3个月肘关节主动屈伸活动范围:A组:屈曲90°～137°,平均125°,伸直0°～27°,平均19°;B组:屈曲90°～129°,平均123°,伸直0°～21°,平均15°。两组无统计学意义(P>0.05)。术后3个月肘关节功能根据MEPS肘关节评分:A组:优9例,良13例,可4例,优良率为84.62%;B组:优2例,良12例,可7例,优良率为66.67%。两组有显著性差异(P<0.05)。A组出现尺骨鹰嘴截骨处内固定松动2例,B组无内固定松动病例,差异有统计学意义(P<0.05)。结论两种手术入路均安全有效,尺骨鹰嘴截骨入路较肱三头肌切开入路可获得更为满意的临床效果,但增加了内固定松动的风险。

Efficacy analysis of two surgical approaches for condylar fracture in elder patients

Objective Compare the efficacy of two different dual-plate fixations,olecranon osteotomy and triceps cut,in the treatment of condylar fractures in elderly patients. Methods 47 elderly patients suffered from condylar fracture admitted from July 2005 to January 2009 were retrospectively analyzed.They were treated by one of the two different approaches randomly,olecranon osteotomy(Group A) or triceps cut(Group B).Three subjects were compared in two groups: ① Hospital stay,fracture healing time;②Active range of elbow flexion and extension 3 months after surgery;③Assessment of elbow function 3 months after surgery with Mayo elbow performance score system(MEPS).Results An average follow up was(12±2.3) months.Incisions were all healed without wound infection or ulnar nerve injury in all patients.The mean hospital stay were(17±3.5) days and(18±3.0) days respectively in two groups,without statistically significance(P>0.05).Fracture healing time was(7±1.5) weeks and(7±1.3) weeks respectively in two groups,without statistically significance(P>0.05).The active range of elbow flexion and extension 3 months after surgery in two groups was also no statistically significance(P> 0.05).Group A: flexion 90°~137°,an average of 125°,extension 0°~27°,an average of 19°;Group B: flexion 90°~129°,an average of 123°,extension 0°~21°,an average of 15 °.MEPS assessment 3 months after surgery was significant different in two groups(P<0.05).Group A: excellent of 9 cases,good of 13 cases,okay of 4 cases,good rate of 84.62%;Group B: excellent of 2 cases,good of 12 cases,okay of 7 cases,good rate of 66.67%.Two cases were found olecranon osteotomy fixation loosening in Group A,none in group B.It was statistically significant(P<0.05).Conclusion Both surgical approaches are safe and effective.The olecranon osteotomy is better than the triceps cut in clinical consequences,but gets an increase in the loosening risk.