Iwamoto Takuji, Suzuki Taku, Matsumura Noboru, Nakamura Masaya, Matsumoto Morio, Sato Kazuki
Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan.
J Hand Surg Am. 2017 May;42(5):344-350. doi: 10.1016/j.jhsa.2017.02.004. Epub 2017 Mar 27.
To assess the outcomes of the lateral para-olecranon triceps-splitting approach for the treatment of distal humeral fracture.
Ten patients (3 males, 7 females) with a mean age of 59 years were retrospectively reviewed. There were 2 A2, 3 C1, and 5 C2 fractures according to the AO/ASIF classification. Types B3 and C3 fractures were excluded from this study because the olecranon osteotomy approach was indicated to visualize the anterior fragment. The triceps was split at the midline, and the anconeus muscle was incised from the proximal ulna. The lateral half of the triceps along with anconeus was retracted laterally as a single unit. The distal part of the humerus could be visualized from medial and lateral windows by retracting the medial half of the triceps. The articular fragment was anatomically reduced and fixed temporarily with a Kirschner wire, and the reconstructed distal articular block was then fixed to the humeral shaft with double locking plates.
After surgery, average elbow flexion was 127° (range, 110°-145°), and extension was -10° (range, -20°-0°) at the average follow-up time of 12.4 months (range, 8‒20 months). Seven patients had normal muscle strength against full resistance (manual muscle testing grade 5), and the other 3 patients had slightly reduced muscle strength (grade 4). No articular stepoffs of more than 1 mm were seen on postoperative radiographs. There were no cases of triceps insufficiency and nonunion. The average (± SD) Mayo Elbow Score was 93.5 ± 5.8 points at the final follow-up.
The lateral para-olecranon approach is useful for the management of selected fractures of the distal humerus, preserving extension strength and providing satisfactory clinical outcomes, with no risk of olecranon osteotomy-related complications.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
评估经尺骨鹰嘴外侧肱三头肌劈开入路治疗肱骨远端骨折的疗效。
回顾性分析10例患者（男性3例，女性7例），平均年龄59岁。根据AO/ASIF分类，有2例A2型、3例C1型和5例C2型骨折。本研究排除B3型和C3型骨折，因为鹰嘴截骨入路用于显露前方骨折块。在中线处劈开肱三头肌，并从尺骨近端切开肘肌。肱三头肌外侧半与肘肌作为一个整体向外侧牵开。通过牵开肱三头肌内侧半，可从内侧和外侧窗口观察肱骨远端。将关节骨折块解剖复位，用克氏针临时固定，然后用双锁定钢板将重建的远端关节骨块固定于肱骨干。
术后平均随访12.4个月（8 - 20个月），平均肘关节屈曲127°（范围110° - 145°），伸展为 - 10°（范围 - 20° - 0°）。7例患者肌肉力量正常，可抵抗完全阻力（徒手肌力测试5级），另外3例患者肌肉力量稍有减弱（4级）。术后X线片未见关节台阶超过1 mm。无肱三头肌功能不全和骨不连病例。末次随访时，Mayo肘关节评分平均（±标准差）为93.5 ± 5.8分。
经尺骨鹰嘴外侧入路对治疗特定的肱骨远端骨折有效，可保留伸展力量并提供满意的临床疗效，且无鹰嘴截骨相关并发症的风险。
研究类型/证据水平：治疗性研究V级
