确定螺钉和垫圈固定作为一种用于固定在肱骨远端关节内骨折手术治疗中所采用的鹰嘴截骨术的方法的疗效。
Determining the efficacy of screw and washer fixation as a method for securing olecranon osteotomies used in the surgical management of intraarticular distal humerus fractures.
作者信息
Woods Barrett I, Rosario Bedda L, Siska Peter A, Gruen Gary S, Tarkin Ivan S, Evans Andrew R
机构信息
*Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; and †Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.
出版信息
J Orthop Trauma. 2015 Jan;29(1):44-9. doi: 10.1097/BOT.0000000000000131.
OBJECTIVES
The purpose of this study was to critically evaluate the efficacy of single screw and washer fixation in comparison with other methods for securing olecranon osteotomies. The hypothesis is that screw and washer fixation is a safe and effective means of olecranon osteotomy fixation with fusion and complication rates similar to other methods of fixation.
DESIGN
Retrospective review.
SETTING
Two Level I Urban Trauma Centers.
PATIENTS/PARTICIPANTS: Patients were treated within the last 20 years and received 1 of 4 types of fixation (screw and washer alone, screw and washer augmented with tension band, tension band alone, or plate and screws) after osteotomy.
INTERVENTION
Open reduction and internal fixation of OTA/AO 13B/C distal humerus fractures with an olecranon osteotomy.
MAIN OUTCOME MEASUREMENTS
The primary outcome measure was the presence of osteotomy union. Secondary outcome measures were olecranon nonunion, loss of articular reduction, and removal of hardware. Logistic regression was used to determine the associations between method of osteotomy fixation and removal of hardware or nonunion rates. Comorbidities were stratified using the Charlson comorbidity index.
RESULTS
One hundred sixty patients met the inclusion criteria. Thirty-nine patients underwent screw fixation alone, 47 had tension band fixation, 16 had plate fixation, and 58 had tension band and screw fixation. Screw fixation demonstrated equal or better rates of union, maintenance of reduction, absence of infection, and implant removal compared with alternative fixation techniques. Higher Charlson scores were associated with higher rates of nonunion.
CONCLUSIONS
Screw and washer fixation is a safe and effective means of securing an olecranon osteotomy. Charlson comorbidity score is one factor that may influence the development of nonunion after osteotomy.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
目的
本研究的目的是严格评估单螺钉和垫圈固定与其他固定鹰嘴截骨术方法相比的疗效。假设是螺钉和垫圈固定是一种安全有效的鹰嘴截骨术固定方法，其融合率和并发症发生率与其他固定方法相似。
设计
回顾性研究。
地点
两家一级城市创伤中心。
患者/参与者：患者在过去20年内接受治疗，截骨术后接受四种固定类型之一（仅螺钉和垫圈、螺钉和垫圈加张力带、仅张力带或钢板和螺钉）。
干预措施
采用鹰嘴截骨术切开复位内固定治疗OTA/AO 13B/C型肱骨远端骨折。
主要观察指标
主要观察指标是截骨术愈合情况。次要观察指标是鹰嘴不愈合、关节复位丢失和内固定取出。采用逻辑回归确定截骨术固定方法与内固定取出或不愈合率之间的关联。使用Charlson合并症指数对合并症进行分层。
结果
160例患者符合纳入标准。39例患者仅接受螺钉固定，47例接受张力带固定，16例接受钢板固定，58例接受张力带和螺钉固定。与其他固定技术相比，螺钉固定在愈合率、复位维持、无感染和内固定取出率方面表现相同或更好。较高的Charlson评分与较高的不愈合率相关。
结论
螺钉和垫圈固定是固定鹰嘴截骨术的一种安全有效的方法。Charlson合并症评分是可能影响截骨术后不愈合发生的一个因素。
证据水平
治疗性三级。有关证据水平的完整描述，请参阅作者须知。
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