摘要
目的探讨肱三头肌舌瓣成形与经尺骨鹰嘴V形截骨两种入路治疗肱骨髁间骨折的临床疗效。方法 52例肱骨髁间骨折患者分别采用肱三头肌舌瓣成形入路（20例）和经鹰嘴V形截骨入路（32例）治疗,比较两组术后并发症及肘关节功能。结果 52例均获随访,时间9~18个月。肱三头肌舌瓣成形组8例发生异位骨化,2例出现创伤性关节炎表现,1例外侧髁钢板螺钉松动,髁间轻度分离;经鹰嘴截骨组2例出现异位骨化,3例出现创伤性关节炎表现,3例老年患者2.5个月后截骨块仍未愈合,克氏针退出,行石膏固定3~4周后愈合。肘关节功能采用Cassebaum评定标准进行评价,肱三头肌舌瓣成形组：优5例,良7例,可6例,差2例,优良率为60%;经鹰嘴截骨组：优19例,良8例,可2例,差3例,优良率为84.4%。两组比较差异有统计学意义（P〈0.05）。结论经鹰嘴V形截骨入路骨折显露佳,大多能取得满意疗效,但老年患者存在截骨块迟缓愈合或骨不连、克氏针张力带松动等并发症,故老年骨质疏松患者不宜首选此入路。
Objective To study the effects of two approaches of triceps tongue flap and V-shaped olecranon osteotomy for the treatment of intercondylar fracture of humerus.Methods 52 cases of intercondylar fracture of humerus were respectively treated by approach of triceps tongue flap（20 cases） and V-shaped olecranon osteotomy（32 cases）,and the postoperative complications and elbow function were compared.Results 52 cases were followed up for 9~18 months.In triceps tongue flap group,8 patients had heterotopic ossification,2 traumatic arthritis,1 lateral condylar plate screw looseness and mild separation of the intercondylar fragments;In olecranon osteotomy group,2 patients had ectopic ossification,3 traumatic arthritis,3 elderly patients had not yet healed of osteotomy after surgery for 2.5 months,and Kirschner wires exited,and with plaster fixation for 3 to 4 weeks,the osteotomy healed.Elbow function was evaluated by using Cassebaum,for triceps tongue flap group： excellent in 5 cases,good in 7,fair in 6 and poor in 2,and the excellent and good rate was 60%;for olecranon osteotomy group： excellent in 19 cases,good in 8,fair in 2 and poor in 3,and the excellent and good rate was 84.4%.There was significant difference between the two groups（P0.05）.Conclusions The approach of V-shaped olecranon osteotomy reveals well and mostly has a satisfactory efficacy,but for elderly patients,it has the complications of delayed union or block osteotomy nonunion and tension band loosening,so this approach should not be the first choice for elderly patients with osteoporosis.
出处
《临床骨科杂志》
2010年第6期670-672,共3页
Journal of Clinical Orthopaedics
关键词
肱骨髁间骨折
截骨术
入路
尺骨鹰嘴
肱三头肌
intercondylar fracture of humerus
osteotomy
approach
olecranon
triceps
作者简介
周炎，男，主治医师，主要从事创伤骨科研究。
