两种入路肱骨小头骨折开放复位内固定比较

Lateral approach versus olecranon osteotomy approach for open reduction and internal fixation of humeral capitellum frac⁃ tures

摘要:

［目的］比较肘外侧入路与鹰嘴截骨入路开放复位内固定肱骨小头 Dubberley II-IIIB 型骨折的临床疗效。［方法］回顾性分析 2014 年 12 月—2019 年 12 月本院采用开放复位内固定治疗 Dubberley II-IIIB 型肱骨小头骨折 39 例患者的临床资料。 依据术前医患沟通结果，21 例采用外侧入路；18 例采用鹰嘴截骨入路。比较两组围手术期、随访及影像学资料。［结果］两组患者均顺利完成手术，均无神经、血管损伤。外侧组手术切口长度、手术时间及出血量均显著优于截骨组 （P<0.05），但截骨组术后恢复主动活动时间和透视次数显著优于外侧组（P<0.05），两组住院时间比较差异无统计学意义（P>0.05）。两组患者平均随访时间 （18.74±2.65） 个月。随术后时间推移，两组 VAS 评分显著下降，而肘伸屈 ROM 和肘 MEPS 评分显著增加 （P< 0.05）。术后 1 个月，截骨组 VAS 评分、MEPS 评分及肘伸-屈 ROM 均显著优于外侧组（P<0.05），但是，术后 6 个月及术后 12 个月时两组间上述指标的差异均已无统计学意义 （P>0.05）。影像方面，截骨组的骨折复位质量及骨折愈合时间均显著优于外侧组（P<0.05）。［结论］ 相较于外侧入路，鹰嘴截骨入路开放复位内固定 DubberleyII-IIIB 型骨折可以使骨折断端获得更好复位与固定稳定性，允许患者早期活动，从而取得更好的临床疗效。

Abstract:

[Objective] To compare the clinical efficacy of lateral approach (LA) versus olecranon osteotomy approach (OOA) for open reduction and internal fixation (ORIF) of Dubberley type II-IIIB humeral capitellum fractures. [Methods] A retrospective study was con- ducted on 39 patients who underwent ORIF for Dubberley type II-IIIB capitellum fractures in our hospital from December 2014 to Decem- ber 2019. According to the results of preoperative doctor-patient communication, 21 patients had ORIF performed by the LA, while the re- maining 18 patients were by the OOA. The perioperative, follow-up and imaging data of the two groups were compared. [Results] All the pa- tients in both groups had ORIF finished smoothly without serious complications, such as neurovascular injury. The LA group was signifi- cantly superior to the OOA group in terms of incision length, operation time and intraoperative blood loss (P＜0.05) , while the OOA group proved significantly superior to the LA group in terms of intraoperatively fluoroscopic times and time to resume active motion postoperative- ly (P＜0.05) , despite of no a statistically significant difference between them in term of hospital stay (P＞0.05) . With time of follow-up peri- od lasted for (18.74±2.65) months on an average, the VAS scores decreased significantly (P＜0.05) , whereas the elbow flexion extension range of motion (ROM) and Mayo Elbow Performance Score (MEPS) increased significantly in both groups (P＜0.05) . However, the OOA group proved significantly superior to the LA group in terms of VAS and MEPS scores, as well as elbow flexion-extension ROM one month postoperatively (P＜0.05) , whereas which became not statistically significant between the two groups at 6 and 12 months postoperatively (P＞ 0.05) . Radiographically, the OOA group also proved significantly superior to the LA group in terms of fracture reduction quality and frac- ture healing time (P＜0.05) . [Conclusions] Compared with the LA, the OOA used for ORIF of Dubberley type II-IIIB fractures does facili- tate fracture reduction and has more stable internal fixation, which allow active elbow motion earlier to achieve better clinical outcomes.