改良的经肱三头肌筋膜舌形皮瓣入路治疗肱骨远端关节内骨折的临床研究
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摘要
目的评价改良的经肱三头肌筋膜舌形皮瓣入路治疗肱骨远端关节内骨折的临床疗效。方法选取2012年6月-2015年4月该院收取的102例肱骨远端关节内骨折患者作为研究对象,进行前瞻性研究。将所有患者随机分为对照组和观察组,对照组51例采取经典的肱三头肌筋膜舌形皮瓣入路治疗,观察组51例采取改良的肱三头肌筋膜舌形皮瓣入路治疗。术后1、3、6和12个月对患者进行随访,行肘关节前后位、侧位X线检查,用肘关节活动范围、DASH评分(肩臂手功能障碍评分)以及肱三头肌MRC分级对肘功能进行评价。对两组患者的术后并发症进行比较。结果所有入选患者均获得12~14个月随访,平均(12.9±1.1)个月。两组患者的年龄、性别及随访时间等基本信息均无统计学意义(P>0.05)。观察组患者术后3、6和12个月的DASH评分均优于对照组(P<0.05)。观察组患者骨折平均愈合时间短于对照组(P<0.05)。另外,末次随访时观察组患者的DASH评分、肌力评分与屈曲畸形度均优于对照组(P<0.05)。术后头6个月运动范围均得到改善。所有患者均无明显并发症发生。结论针对肱骨远端关节内骨折,改良的经肱三头肌筋膜舌形皮瓣入路可为手术提供理想的可视化效果,同时使患者术后的DASH评分更高,使肘关节的运动范围更接近正常值,与经典的经肱三头肌筋膜舌形皮瓣入路相比具有更好的临床价值,值得进一步推广应用。
Objective To evaluate the clinical effect of operative management of intra-articular fractures of distal humerus using modified triceps tongue flap approach. Methods A total of 102 patients with intra-articular fractures of distal humerus in our hospital from June 2012 to April 2015 were selected as study objects, and randomly divided into experimental group and control group, each group had 51 cases. Modified triceps tongue flap approach was used in the experimental group while classical triceps tongue flap approach was used in the control group. The patients were followed up 1, 3, 6 and 12 months after surgery when standard anteroposterior and lateral(AP/Lat) radiographs were taken and the functional outcome was assessed using range of elbow motion, Disability of Arm, Shoulder and Hand(DASH) score and Objective Muscle Strength Testing(MRC Grade) of triceps muscle. The postoperative complications of the two groups were compared. Results The mean duration of follow-up was(12.9 ± 1.1) months,ranging from 12 to 14 months. There was no significant difference in age, gender, duration of follow-up or other basic information between the two groups(P > 0.05). The DASH score of the experimental group was significant better than that of the control group 3, 6 and 12 months after treatment(P < 0.05). The mean healing duration of fracture in the experimental group was significant shorter than that in the control group(P < 0.05). What's more, the DASH score, muscle strength and flexion deformity of the elbow at final follow-up were all significant better in the experimental group(P < 0.05). The range of motion improved within six months after operation. There was no obvious complication in any patient. Conclusions Modified triceps tongue flap approach provides an excellent exposure as well as a good functional outcome as measured by DASH score and full range of elbow motion with return of almost complete power of the extensor apparatus in patients with intra-articular fractures of distal humerus. Compared with classical triceps tongue flap approach, modified triceps tongue flap approach has better clinical effect, and is worthy of spreading and applying.
Objective To evaluate the clinical effect of operative management of intra-articular fractures of distal humerus using modified triceps tongue flap approach. Methods A total of 102 patients with intra-articular fractures of distal humerus in our hospital from June 2012 to April 2015 were selected as study objects, and randomly divided into experimental group and control group, each group had 51 cases. Modified triceps tongue flap approach was used in the experimental group while classical triceps tongue flap approach was used in the control group. The patients were followed up 1, 3, 6 and 12 months after surgery when standard anteroposterior and lateral(AP/Lat) radiographs were taken and the functional outcome was assessed using range of elbow motion, Disability of Arm, Shoulder and Hand(DASH) score and Objective Muscle Strength Testing(MRC Grade) of triceps muscle. The postoperative complications of the two groups were compared. Results The mean duration of follow-up was(12.9 ± 1.1) months,ranging from 12 to 14 months. There was no significant difference in age, gender, duration of follow-up or other basic information between the two groups(P > 0.05). The DASH score of the experimental group was significant better than that of the control group 3, 6 and 12 months after treatment(P < 0.05). The mean healing duration of fracture in the experimental group was significant shorter than that in the control group(P < 0.05). What's more, the DASH score, muscle strength and flexion deformity of the elbow at final follow-up were all significant better in the experimental group(P < 0.05). The range of motion improved within six months after operation. There was no obvious complication in any patient. Conclusions Modified triceps tongue flap approach provides an excellent exposure as well as a good functional outcome as measured by DASH score and full range of elbow motion with return of almost complete power of the extensor apparatus in patients with intra-articular fractures of distal humerus. Compared with classical triceps tongue flap approach, modified triceps tongue flap approach has better clinical effect, and is worthy of spreading and applying.
引文
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[6]SUN H J,ZHANG Y,XIA C L,et al.Applied anatomical study of the modified anconeus flap approach[J].Surg Radiol Anat,2015,37(9):1049-1054.
[7]NOLAN B M,SWEET S J,FERKEL E,et al.The role of computed tomography in evaluating intra-articular distal humerus fractures[J].Am J Orthop,2015,44(9):E326-330.
[8]CAMPBELL W C.Incision for exposure of the elbow joint[J].The American Journal of Surgery,1932,15(1):65-67.
[9]AZBOY,BULUT M,ANCAR C,et al.The comparison of triceps-reflecting anconeus pedicle and olecranon osteotomy approaches in the treatment of intercondylar fractures of the humerus[J].Ulus Travma Acil Cerrahi Derg,2016,22(1):58-65.
[10]AMIR S,JANNIS S,DANIEL R.Distal humerus fractures:a review of current therapy concepts[J].Curr Rev Musculoskelet Med,2016,9(2):199-206.
[11]CHAN K W,DONNELLY K J.Does K-wire position in tension band wiring of olecranon fractures affect its complications and removal of metal rate[J].J Orthop,2014,12(2):111-117.
[12]DESLOGES W,FABER K J,KING G J,et al.Functional outcomes of distal humeral fractures managed nonoperatively in medically unwell and lower-demand elderly patients[J].J Shoulder Elbow Surg,2015,24(8):1187-1196.
[13]VIPREY M,CAILLET P,CANAT G,et al.Low Osteoporosis Treatment initiation rate in women after distal forearm or proximal humerus fracture:a healthcare database nested cohort study[J].PLo S One,2015,10(12):e0143842.
[14]KOUTALOS A,VARITIMIDIS S,DAILIANA Z,et al.Operative management of humeral nonunions.Factors that influence the outcome[J].Acta Orthop Belg,2015,81(3):501-510.
[2]PANKAJ A,MALLINATH G,MALHOTRA R,et al.Surgical management of intercondylar fractures of the humerus using triceps reflecting anconeuspedicle(TRAP)approach[J].Indian J Orthop,2007,41(3):219-223.
[3]ROULEAU D M,MUTCH J,LAFLAMME G Y.Surgical treatment of displaced greater tuberosity fractures of the humerus[J].JAm Acad Orthop Surg,2016,24(1):46-56.
[4]KHAN K M,KUMAR S,MINHAS M S,et al.Functional outcome following olecranon osteotomy approach for fixation of T/Yfractures of distal humerus[J].J Pak Med Assoc,2015,65(11Suppl 3):S25-27.
[5]SHEMESH S,LOEBENBERG M Y,KOSASHVILI Y,et al.Extended paratricipital approach for intra-articular fractures of the distal humerus[J].Orthopedics,2015,38(7):435-438.
[6]SUN H J,ZHANG Y,XIA C L,et al.Applied anatomical study of the modified anconeus flap approach[J].Surg Radiol Anat,2015,37(9):1049-1054.
[7]NOLAN B M,SWEET S J,FERKEL E,et al.The role of computed tomography in evaluating intra-articular distal humerus fractures[J].Am J Orthop,2015,44(9):E326-330.
[8]CAMPBELL W C.Incision for exposure of the elbow joint[J].The American Journal of Surgery,1932,15(1):65-67.
[9]AZBOY,BULUT M,ANCAR C,et al.The comparison of triceps-reflecting anconeus pedicle and olecranon osteotomy approaches in the treatment of intercondylar fractures of the humerus[J].Ulus Travma Acil Cerrahi Derg,2016,22(1):58-65.
[10]AMIR S,JANNIS S,DANIEL R.Distal humerus fractures:a review of current therapy concepts[J].Curr Rev Musculoskelet Med,2016,9(2):199-206.
[11]CHAN K W,DONNELLY K J.Does K-wire position in tension band wiring of olecranon fractures affect its complications and removal of metal rate[J].J Orthop,2014,12(2):111-117.
[12]DESLOGES W,FABER K J,KING G J,et al.Functional outcomes of distal humeral fractures managed nonoperatively in medically unwell and lower-demand elderly patients[J].J Shoulder Elbow Surg,2015,24(8):1187-1196.
[13]VIPREY M,CAILLET P,CANAT G,et al.Low Osteoporosis Treatment initiation rate in women after distal forearm or proximal humerus fracture:a healthcare database nested cohort study[J].PLo S One,2015,10(12):e0143842.
[14]KOUTALOS A,VARITIMIDIS S,DAILIANA Z,et al.Operative management of humeral nonunions.Factors that influence the outcome[J].Acta Orthop Belg,2015,81(3):501-510.