Illical Emmanuel M, Farrell Dana J, Siska Peter A, Evans Andrew R, Gruen Gary S, Tarkin Ivan S
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Injury. 2014 Oct;45(10):1545-8. doi: 10.1016/j.injury.2014.04.015. Epub 2014 Apr 16.
To compare elbow range of motion (ROM), triceps extension strength, and functional outcome of AO/OTA type A distal humerus fractures treated with a triceps-split or -sparing approach.
Retrospective review.
Two level one trauma centres.
Sixty adult distal humerus fractures (AO/OTA 13A2, 13A3) presenting between 2008 and 2012 were reviewed. Exclusion criteria removed 18 total patients from analysis and three patients died before final follow-up.
Patients were divided into two surgical approach groups chosen by the treating surgeon: triceps split (16 patients) or triceps sparing (23 patients).
Elbow ROM and triceps extension strength testing were completed in patients after fractures had healed. All patients were also given the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.
Compared to the triceps-split cohort, the triceps-sparing cohort had greater elbow flexion (sparing 143 ± 7° compared to split 130 ± 12°, p=0.03) and less extension contracture (sparing 6 ± 8° compared to split 23 ± 4°, p<0.0001). Triceps strength compared to the uninjured arm also favoured the triceps-sparing cohort (sparing 88.9 ± 28.3% compared to split 49.4 ± 17.0%, p=0.007). DASH scores were not statistically significant between the two cohorts (sparing 14.5 ± 12.2 compared to split 23.6 ± 22.3, p=0.333).
A triceps-sparing approach for surgical treatment of extra-articular distal humerus fractures can result in better elbow ROM and triceps strength than a triceps-splitting approach. Both approaches, however, result in reliable union and similar functional outcome.
Level III.
比较采用肱三头肌劈开或保留入路治疗的AO/OTA A型肱骨远端骨折患者的肘关节活动范围（ROM）、肱三头肌伸展力量及功能结局。
回顾性研究。
两家一级创伤中心。
对2008年至2012年间出现的60例成人肱骨远端骨折（AO/OTA 13A2、13A3）进行回顾。排除标准使18例患者被排除在分析之外，3例患者在最终随访前死亡。
患者被治疗外科医生分为两种手术入路组：肱三头肌劈开组（16例患者）和肱三头肌保留组（23例患者）。
骨折愈合后对患者进行肘关节ROM和肱三头肌伸展力量测试。所有患者还接受了上肢、肩部和手部功能障碍（DASH）问卷调查。
与肱三头肌劈开组相比，肱三头肌保留组肘关节屈曲角度更大（保留组为143±7°，劈开组为130±12°，p=0.03），伸展挛缩更少（保留组为6±8°，劈开组为23±4°，p<0.0001）。与健侧手臂相比，肱三头肌力量也更有利于肱三头肌保留组（保留组为88.9±28.3%，劈开组为49.4±17.0%，p=0.007）。两组间DASH评分无统计学差异（保留组为14.5±12.2，劈开组为23.6±22.3，p=0.333）。
对于关节外肱骨远端骨折的手术治疗，肱三头肌保留入路比肱三头肌劈开入路能带来更好的肘关节ROM和肱三头肌力量。然而，两种入路均能实现可靠愈合且功能结局相似。
三级。
