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[1]張川,張作君,蔡鴻敏,等.帶肘肌肌瓣尺骨鷹嘴不規(guī)則截骨入路和V形截骨入路治療肱骨遠(yuǎn)端C3型骨折的對比研究[J].中醫(yī)正骨,2017,29(12):26-30.
　ZHANG Chuan,ZHANG Zuojun,CAI Hongmin,et al.A retrospective trial of irregular osteotomy approach versus V-shape osteotomy approach in anconeus flap olecranon osteotomy for treatment of type C3 distal humeral fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(12):26-30.
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帶肘肌肌瓣尺骨鷹嘴不規(guī)則截骨入路和V形截骨入路治療肱骨遠(yuǎn)端C3型骨折的對比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年12期
頁碼:
26-30
欄目:
臨床研究
出版日期:
2017-12-20

文章信息/Info

Title:
A retrospective trial of irregular osteotomy approach versus V-shape osteotomy approach in anconeus flap olecranon osteotomy for treatment of type C3 distal humeral fractures
作者:
張川; 張作君; 蔡鴻敏; 昌中孝; 楊林平; 趙明; 李星星; 王國杰; 段小波
河南省洛陽正骨醫(yī)院/河南省骨科醫(yī)院,河南 洛陽 471002
Author(s):
ZHANG Chuan; ZHANG Zuojun; CAI Hongmin; CHANG Zhongxiao; YANG Linping; ZHAO Ming; LI Xingxing; WANG Guojie; DUAN Xiaobo
Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China
關(guān)鍵詞:
肱骨骨折;  尺骨鷹嘴;  骨折固定術(shù); 內(nèi);  截骨術(shù);  臨床試驗
Keywords:
Key words humeral fractures;  olecranon process;  fracture fixation; internal;  osteotomy;  clinical trial
摘要:
目的:比較帶肘肌肌瓣尺骨鷹嘴不規(guī)則截骨入路和V形截骨入路治療肱骨遠(yuǎn)端C3型骨折的臨床療效和安全性。方法:2013年1月至2015年11月,采用帶肘肌肌瓣的尺骨鷹嘴截骨入路行雙柱解剖鎖定接骨板內(nèi)固定治療肱骨遠(yuǎn)端C3型骨折患者29例,15例采用尺骨鷹嘴不規(guī)則截骨(不規(guī)則截骨組)、14例采用尺骨鷹嘴V形截骨(V形截骨組)。比較2組患者的手術(shù)時間、肘關(guān)節(jié)屈伸活動范圍、總體療效及并發(fā)癥發(fā)生情況。總體療效評價采用Mayo肘關(guān)節(jié)功能評分量表。結(jié)果:所有患者均順利完成手術(shù),2組患者的手術(shù)時間比較,差異無統(tǒng)計學(xué)意義[(122.6±12.6)min,(114.6±10.3)min,t=1.711,P=0.098]。所有患者均獲得隨訪; 不規(guī)則截骨組隨訪11～29個月,中位數(shù)20.5個月; V形截骨組隨訪14～37個月,中位數(shù)24個月。不規(guī)則截骨組中術(shù)前合并尺神經(jīng)損傷和橈神經(jīng)損傷的患者分別于術(shù)后3個月和術(shù)后5個月恢復(fù)。不規(guī)則截骨組2例發(fā)生異位骨化; 1例出現(xiàn)切口淺表感染,應(yīng)用抗生素后治愈。V形截骨組1例發(fā)生異位骨化; 1例以張力帶鋼絲固定尺骨鷹嘴截骨塊的患者,術(shù)后1周功能鍛煉時鋼絲斷裂,再次手術(shù)更換鋼絲固定,2個月后鷹嘴截骨部位愈合。2組患者均未發(fā)生截骨部位延遲愈合或不愈合。2組患者的并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學(xué)意義(P=1.000)。末次隨訪時,2組患者的肘關(guān)節(jié)屈伸活動范圍比較,差異無統(tǒng)計學(xué)意義(88.7°±11.3°,86.7°±10.8°,t=0.458,P=0.651); 按照Mayo肘關(guān)節(jié)功能評分量表評定總體療效,不規(guī)則截骨組優(yōu)4例、良7例、可4例,V形截骨組優(yōu)5例、良6例、可3例。2組患者的總體療效比較,差異無統(tǒng)計學(xué)意義(Z=-0.516,P=0.606)。結(jié)論:經(jīng)帶肘肌肌瓣尺骨鷹嘴不規(guī)則截骨入路和V形截骨入路治療肱骨遠(yuǎn)端C3型骨折的療效和安全性相當(dāng)。
Abstract:
ABSTRACT Objective:To compare the clinical curative effects and safety of irregular osteotomy approach versus V-shape osteotomy approach in anconeus flap olecranon osteotomy for treatment of type C3 distal humeral fractures.Methods:Twenty-nine patients received double rods anatomical locking plate internal fixation through anconeus flap olecranon osteotomy approach for treatment of type C3 distal humeral fracture from January 2013 to November 2015.Fifteen patients were treated with irregular osteotomy of olecranon(irregular osteotomy group),while the others were treated with V-shape osteotomy of olecranon(V-shape osteotomy group).The operative times,elbow flexion-extension range,total curative effect and postoperative complications were compared between the 2 groups,and the total curative effects were evaluated by using Mayo elbow joint function scale.Results:The surgery was finished successfully in all patients and there was no statistical difference in operative time between the 2 groups(122.6+/-12.6 vs 114.6+/-10.3 min,t=1.711,P=0.098).All patients in the 2 groups were followed up.The patients in irregular osteotomy group were followed up for 11-29 months with a median of 20.5 months,and the patients in V-shape osteotomy group were followed up for 14-37 months with a median of 24 months.The patients with pre-surgery ulnar nerve injury or radial nerve injury in irregular osteotomy group recovered at 3 and 5 months after the surgery respectively.In irregular osteotomy group,the heterotopic ossifications were found in two patients and the superficial incision infection was found in one patient,who was cured after application of antibiotics.In V-shape osteotomy group,the heterotopic ossification was found in one patient and the tension band steel-wire which was fixing the olecranon bone block broke in one patient when he was taking functional exercise at 1 week after surgery,then reoperation was performed to replace the broken steel-wire,and the osteotomy site of olecranon was healed 2 months later.Neither delayed union nor nonunion of osteotomy site was found in both of the 2 groups.There was no statistical difference in complication incidences between the 2 groups(P=1.000).There was no statistical difference in elbow flexion-extension range between the 2 groups at the last follow-up(88.7+/-11.3 vs 86.7+/-10.8 degrees,t=0.458,P=0.651).The clinical comprehensive curative effects were evaluated according to Mayo elbow joint function scale.Four patients obtained an excellent result,7 good and 4 fair in irregular osteotomy group; while 5 patients obtained an excellent result,6 good and 3 fair in V-shape osteotomy group.There was no statistical difference in clinical total curative effects between the 2 groups(Z=-0.516,P=0.606).Conclusion:Irregular anconeus flap olecranon osteotomy approach and V-shape anconeus flap olecranon osteotomy approach are similar to each other in the curative effects and safty in treatment of type C3 distal humeral fractures.

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備注/Memo

備注/Memo:
基金項目:河南省科技攻關(guān)計劃項目(152102310164) 通訊作者:張作君 E-mail:[email protected]
更新日期/Last Update: 2018-05-02