Mühldorfer-Fodor Marion, Bekler Halil, Wolfe Valerie M, McKean Jason, Rosenwasser Melvin Paul
Clinic for Hand Surgery Bad Neustadt, Bad Neustadt an der Saale, Federal Republic of Germany.
Tech Hand Up Extrem Surg. 2011 Sep;15(3):156-61. doi: 10.1097/BTH.0b013e318206f115.
Commonly, distal transcondylar and intra-articular distal humerus fractures are treated through a transolecranon approach. Other options for exposure, open reduction, and internal fixation exist to prevent the reported complications of olecranon osteotomy. The technique of triceps sparing access, as it has been reported before by others, allow adequate exposure in most of distal humerus fractures except for multifragmentary, mainly intra-articular types. We demonstrate the technique of the "two-window" approach, which combines a paratricipital posteromedial access with splitting the triceps lateral to the triceps tendon. Through a posteromedial incision, all surfaces of the distal humerus were accessed without muscle detachment from the olecranon. This approach does not compromise the ligamentous joint stability. In addition, the stabilizing effect of the anconeus muscle is not impaired because continuity with the lateral portion of the triceps is preserved, and denervation is avoided. It is extensile and provides adequate exposure of articular fracture comminution with the added advantage of the intact olecranon as a template for reduction. However, because the triceps is still in continuity it permits conversion to a transolecranon approach as necessary. The two-window approach is our preferred approach for all distal humerus fractures inclusively C3 fractures according to the ASIF/AO classification, except for complex volar shear fractures.
通常，肱骨远端髁上和关节内骨折通过经鹰嘴入路进行治疗。为避免鹰嘴截骨术所报道的并发症，还存在其他用于显露、切开复位和内固定的选择。如前人所报道，保留肱三头肌的入路技术能在除多块骨折（主要是关节内骨折类型）外的大多数肱骨远端骨折中提供充分显露。我们展示了“双窗口”入路技术，该技术将肱三头肌旁后内侧入路与肱三头肌腱外侧劈开肱三头肌相结合。通过后内侧切口，可在不将肌肉从鹰嘴处分离的情况下显露肱骨远端的所有表面。这种入路不会损害关节韧带稳定性。此外，由于保留了肱三头肌外侧部分的连续性且避免了神经去神经化，所以肘肌的稳定作用未受损害。它具有扩展性，能充分显露关节骨折的粉碎情况，还有完整鹰嘴作为复位模板这一额外优势。然而，由于肱三头肌仍保持连续性，必要时可转换为经鹰嘴入路。根据ASIF/AO分类，“双窗口”入路是我们治疗所有肱骨远端骨折（包括C3骨折）的首选入路，但复杂的掌侧剪切骨折除外。
