Schildhauer Thomas A, Nork Sean E, Mills William J, Henley M Bradford
Department of Orthopaedics, Harborview Medical Center, University of Washington, Seattle, USA.
J Orthop Trauma. 2003 May;17(5):374-8. doi: 10.1097/00005131-200305000-00009.
Adequate exposure of the articular surface of the distal humerus and elbow joint is required for operative stabilization of bicolumnar distal humerus fractures. The transolecranon approach, which provides complete posterior visualization and access to the distal humerus, is commonly used. Nevertheless, an olecranon osteotomy and other extensor mechanism-disrupting approaches have risks and possible complications. Alternative exposures have been described primarily for total elbow arthroplasty, but these involve extensive and potentially devascularizing dissections. In extra-articular (OTA type A) and simple articular distal humeral fractures with simple or multifragmentary metaphyseal involvement (OTA type C1 and C2), extensile approaches may not be necessary. For these fracture patterns, an alternative exposure is the extensor mechanism-sparing paratricipital posterior approach to the distal humerus through a midline posterior incision. This approach avoids an osteotomy and mobilizes the triceps and anconeus muscle off the posterior humerus and the intermuscular septae and provides adequate exposure for open reduction and internal fixation.
对于双柱型肱骨远端骨折的手术稳定，需要充分暴露肱骨远端和肘关节的关节面。经鹰嘴入路可提供肱骨远端完整的后方视野并能进入该区域，是常用的方法。然而，鹰嘴截骨术及其他破坏伸肌机制的入路存在风险和可能的并发症。主要针对全肘关节置换术描述了一些替代暴露方法，但这些方法涉及广泛且可能导致血管损伤的解剖。对于关节外（OTA A型）和伴有简单或多块干骺端骨折的简单关节内肱骨远端骨折（OTA C1和C2型），可能无需采用扩大入路。对于这些骨折类型，一种替代暴露方法是通过后正中切口采用保留伸肌机制的肱骨远端经肱三头肌后入路。该方法避免了截骨，将肱三头肌和肘肌从肱骨后方及肌间隔上掀起，为切开复位内固定提供了充分暴露。
