改良经肱三头肌内外侧入路微创复位内固定治疗AO-C型肱骨远端骨折疗效观察

目的比较改良经肱三头肌内外侧入路微创复位与肘后切口关节囊切开复位垂直钢板内固定治疗AO-C型肱骨远端骨折的临床疗效。方法回顾性分析自2010-01—2018-10诊治的AO-C型肱骨远端骨折,22例采用改良经肱三头肌内外侧入路髁间骨折双环复位、滑车轴心固定、垂直钢板内固定(改良组),22例采用肘后直切口关节囊切开复位垂直钢板内固定(常规组)。比较2组手术时间、术中出血量、住院时间、康复介入时间、术后3 d疼痛VAS评分及末次随访时肘关节功能Jupiter评分。结果 44例均获得随访,改良组平均13.9个月,常规组平均15.7个月。骨折均获得骨性愈合后患者要求取出内固定。首次手术与内固定取出手术时,改良组手术时间较常规组短,术中出血量较开放组少,康复介入时间较常规组早,术后3d疼痛VAS评分较常规组低,差异有统计学意义(P <0.05)。改良组末次随访时肘关节功能Jupiter评分优于常规组,差异有统计学意义(P <0.05)。结论改良经肱三头肌内外侧入路微创复位髁间骨折、确定双环复位标准、滑车轴心固定、垂直钢板内固定治疗AO-C型肱骨远端骨折可以显著提高手术疗效,减轻患者术后疼痛,加快患者术后康复。

Therapeutic effect of minimally invasive reduction and internal fixation through improved internal and external approach of triceps brachii for AO type C distal humeral fractures

Objective To compare the clinical efficacy of the modified internal and external triceps brachii approach vertical plate internal fixation for AO-C type distal humeral fractures.Methods From January 2010 to October 2018,22 cases of AO-C type distal humeral fractures were treated by modified internal and external approach of triceps brachii,Fixed axle center and vertical plate internal fixation(improved group).Another 22 cases were treated by open reduction of articular capsule with straight incision and vertical plate internal fixation(conventional group).The operative time,intraoperative hemorrhage,hospitalization time,rehabilitation intervention time,the pain VAS score 3 days after operation and Jupiter score of elbow joint function in the last follow-up were compared between the two groups.Results Forty-four cases were followed up,the average follow-up time was 13.9 months in the improved group,15.7 months in the conventional group.After all the fractures were healed,the patients required to take out the internal fixation.During the first operation and removal of internal fixation,the operation time of the improved group was shorter than that of the conventional group,the amount of intraoperative bleeding of improved was less than that of the conventional group,the rehabilitation intervention time was earlier than that of the conventional group,and the VAS score of postoperative pain was lower than that of the conventional group(P<0.05).At the last follow-up,the Jupiter score of elbow joint function in the improved group was better than that in the conventional group,and the difference was statistically significant(P<0.05).Conclusion The treatment of AO-C type distal humeral fracture with modified internal and external approach of triceps brachii can significantly improve the operative effect,reduce postoperative pain and accelerate postoperative rehabilitation.