肱三头肌肘肌翻转入路与尺骨鹰嘴截骨入路治疗肱骨髁间骨折的疗效对比
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摘要
目的评估肱三头肌肘肌翻转入路(TRAP)与尺骨鹰嘴截骨入路治疗肱骨髁间骨折的临床疗效。方法回顾性分析2006年3月—2012年6月陕西省核工业215医院收治的180例肱骨远端关节内骨折患者。所有患者中99例采用TRAP治疗(男性54例,女性45例;年龄22~61岁,平均36.6岁);81例采用尺骨鹰嘴截骨入路治疗(男性49例,女性32例;年龄26~57岁,平均35.4岁)。使用AO/ASIF分型系统对骨折进行分型。记录和比较患者的术后Mayo肘关节评分(MEPS评分)和肩臂手功能障碍评分(DASH评分)对患侧关节功能进行评价。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14~74个月随访,平均33.6个月。两组患者的年龄、性别等基本信息差异均无统计学意义(P>0.05)。末次随访TRAP组患者的平均肘关节运动范围为(108.2±21.9)°,尺骨鹰嘴截骨入路组患者的平均肘关节运动范围为(98.7±22.7)°,两组相比差异具有统计学意义(P<0.05)。两组患者术后1、6、12个月的平均MEPS评分与DASH评分相比差异均无统计学意义(P>0.05)。TRAP组患者的术后并发症发生率为27.3%,显著低于尺骨鹰嘴截骨入路组(54.3%,P<0.05)。结论与尺骨鹰嘴截骨入路相比,肱三头肌肘肌翻转入路能显著提高肱骨髁间骨折患者术后肘关节的活动范围、降低术后并发症的发生率。
Objective To evaluate the functional outcomes of patients with intra-articular distal humerus fractures treated with triceps-reflecting anconeus pedicle( TRAP) approach and olecranon osteotomy approach.Methods A total of 180 patients with intra-articular distal humerus fractures in our hospital from Mar. 2006 to Jun.2012 were recruited to carry out a retrospective study. TRAP approach was used in 99 patients( 54 males,45 females; age from 22-61 years,mean age 36. 6 years),and olecranon osteotomy in 81 patients( 49 males,32 females;age from 26-57 years,mean age 35. 4 years). Fractures were classified using the AO/ASIF classification. Functional results were evaluated with the Mayo elbow performance score( MEPS) and the Disabilities of Arm,Shoulder and Hand( DASH) questionnaire score. The postoperative complications of patients in different groups were compared.Results The mean duration of follow-up was 33. 6 months( ranged from 14 to 74 months). There was no significant difference in age,gender or other basic data between two groups( P > 0. 05). The overall arc of elbow motion at the last follow-up was( 108. 2 ± 21. 9) ° in the TRAP group,whereas( 98. 7 ± 22. 7) ° in the olecranon osteotomy group. A significant difference was observed between the two groups in terms of overall mean arc of elbow motion( P < 0. 05). There was no significant difference between the two groups in mean MEPS and DASH scores at 1,6,12 month after treatment( P > 0. 05). The overall complication rate in the TRAP group was 27. 3%,which was significantly lower than that in the olecranon osteotomy group( 54. 3%,P < 0. 05). Conclusion TRAP is an effective approach in the treatment of intra-articular distal humerus fractures that provides better arc of elbow and lower complication and reoperation rates.
Objective To evaluate the functional outcomes of patients with intra-articular distal humerus fractures treated with triceps-reflecting anconeus pedicle( TRAP) approach and olecranon osteotomy approach.Methods A total of 180 patients with intra-articular distal humerus fractures in our hospital from Mar. 2006 to Jun.2012 were recruited to carry out a retrospective study. TRAP approach was used in 99 patients( 54 males,45 females; age from 22-61 years,mean age 36. 6 years),and olecranon osteotomy in 81 patients( 49 males,32 females;age from 26-57 years,mean age 35. 4 years). Fractures were classified using the AO/ASIF classification. Functional results were evaluated with the Mayo elbow performance score( MEPS) and the Disabilities of Arm,Shoulder and Hand( DASH) questionnaire score. The postoperative complications of patients in different groups were compared.Results The mean duration of follow-up was 33. 6 months( ranged from 14 to 74 months). There was no significant difference in age,gender or other basic data between two groups( P > 0. 05). The overall arc of elbow motion at the last follow-up was( 108. 2 ± 21. 9) ° in the TRAP group,whereas( 98. 7 ± 22. 7) ° in the olecranon osteotomy group. A significant difference was observed between the two groups in terms of overall mean arc of elbow motion( P < 0. 05). There was no significant difference between the two groups in mean MEPS and DASH scores at 1,6,12 month after treatment( P > 0. 05). The overall complication rate in the TRAP group was 27. 3%,which was significantly lower than that in the olecranon osteotomy group( 54. 3%,P < 0. 05). Conclusion TRAP is an effective approach in the treatment of intra-articular distal humerus fractures that provides better arc of elbow and lower complication and reoperation rates.
引文
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[6]Rouleau DM,Mutch J,Laflamme GY.Surgical treatment of displaced greater tuberosity fractures of the humerus[J].J Am Acad Orthop Surg,2016,24(1):46-56.
[7]孙焕建,吴加东,朱文峰,等.改良肘肌瓣入路治疗肱骨远端髁间骨折[J].中华创伤骨科杂志,2016,18(7):586-591.
[8]Wolfe SW,Ranawat CS.The osteo-anconeus flap.An approach for total elbow arthroplasty[J].J Bone Joint Surg(Am),1990,72(5):684-688.
[9]Sun HJ,Zhang Y,Xia CL,et al.Applied anatomical study of the modified anconeus flap approach[J].Surg Radiol Anat,2015,37(9):1049-1054.
[10]王振龙,华强,严光建,等.经肱三头肌劈开入路治疗C型肱骨远端骨折的疗效分析[J].骨科,2015,6(3):145-148.
[11]沈彦,王朝阳,吴兴旺,等.不同手术方式治疗肱骨远端骨折的疗效观察[J].创伤外科杂志,2015,17(3):217-221.
[12]吴维国,黄斌,罗靖致,等.成人肱骨远端骨折术后肘关节功能恢复的影响因素分析[J].中国现代医生,2013,51(34):53-56.
[13]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.
[14]王祖如,衣英豪,王汝武,等.肱三头肌肘肌翻转入路手术治疗肱骨远端髁间骨折[J].山东医药,2012,52(14):83-84.
[2]杜利兵,乔虎云,梁炳生.成人肱骨远端骨折治疗的研究进展[J].实用骨科杂志,2014,20(12):1111-1114.
[3]邵锋,卢绪章.切开复位内固定治疗老年人肱骨远端骨折的疗效及影响因素分析[J].新乡医学院学报,2015,32(5):444-445.
[4]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.
[5]O’Driscoll SW.The triceps-reflecting anconeus pedicle(TRAP)approach for distal humeral fractures and nonunions[J].Orthop Clin North(Am),2000,31(1):91-101.
[6]Rouleau DM,Mutch J,Laflamme GY.Surgical treatment of displaced greater tuberosity fractures of the humerus[J].J Am Acad Orthop Surg,2016,24(1):46-56.
[7]孙焕建,吴加东,朱文峰,等.改良肘肌瓣入路治疗肱骨远端髁间骨折[J].中华创伤骨科杂志,2016,18(7):586-591.
[8]Wolfe SW,Ranawat CS.The osteo-anconeus flap.An approach for total elbow arthroplasty[J].J Bone Joint Surg(Am),1990,72(5):684-688.
[9]Sun HJ,Zhang Y,Xia CL,et al.Applied anatomical study of the modified anconeus flap approach[J].Surg Radiol Anat,2015,37(9):1049-1054.
[10]王振龙,华强,严光建,等.经肱三头肌劈开入路治疗C型肱骨远端骨折的疗效分析[J].骨科,2015,6(3):145-148.
[11]沈彦,王朝阳,吴兴旺,等.不同手术方式治疗肱骨远端骨折的疗效观察[J].创伤外科杂志,2015,17(3):217-221.
[12]吴维国,黄斌,罗靖致,等.成人肱骨远端骨折术后肘关节功能恢复的影响因素分析[J].中国现代医生,2013,51(34):53-56.
[13]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.
[14]王祖如,衣英豪,王汝武,等.肱三头肌肘肌翻转入路手术治疗肱骨远端髁间骨折[J].山东医药,2012,52(14):83-84.