Fernández-Valencia J A, Muñoz-Mahamud E, Ballesteros J R, Prat S
Department of Orthopaedic and Trauma Surgery, Hospital Clínic, University of Barcelona, C/Villarroel 170, 08036 Barcelona, Spain.
ISRN Orthop. 2013 Mar 20;2013:525326. doi: 10.1155/2013/525326. eCollection 2013.
Several alternative approaches have been described to avoid the complications related to the olecranon osteotomy used to treat distal articular humerus fractures. The published experience with the triceps-sparing approach is scant. In this prospective study, a total of 12 patients with an articular humeral fracture were treated using this approach. At a mean followup of 1,7 years, the average range of motion was 112.8° (range from 85° to 135°); the elbow flexion averaged 125.5° (range from 112° to 135°) and the deficit of elbow extension 14.6° (range from 0° to 30°). All the elbows were stable. The Mayo Elbow Performance Score (MEPS) averaged 93.3 (range from 80 to 100). In the present series no failure of the triceps reattachment to the olecranon was found, and all the patients recalled returning to their previous daily life activities without impairment with a satisfactory MEPS. As a conclusion, the triceps-sparing approach can be considered for treating distal articular humerus fractures. We consider that three clinical settings can be more favorable to use this approach: those cases in which a total elbow prosthesis might be needed, cases of ipsilateral diaphyseal fracture, or presence of previous hardware in the olecranon.
已经描述了几种替代方法来避免与用于治疗肱骨远端关节骨折的鹰嘴截骨术相关的并发症。关于保留肱三头肌方法的已发表经验很少。在这项前瞻性研究中，共有12例肱骨关节骨折患者采用了这种方法进行治疗。平均随访1.7年时，平均活动范围为112.8°（范围从85°至135°）；肘关节屈曲平均为125.5°（范围从112°至135°），肘关节伸展不足为14.6°（范围从0°至30°）。所有肘关节均稳定。梅奥肘关节功能评分（MEPS）平均为93.3（范围从80至100）。在本系列中，未发现肱三头肌重新附着于鹰嘴失败的情况，并且所有患者回忆说能够恢复到之前的日常生活活动，且功能评分满意，没有功能障碍。总之，保留肱三头肌的方法可考虑用于治疗肱骨远端关节骨折。我们认为有三种临床情况可能更适合使用这种方法：可能需要全肘关节置换的病例、同侧骨干骨折的病例或鹰嘴先前有内固定物的情况。
