Zhang Tenglong, Xu Tao, Liang Hong, Lan Lin, Luo Qiang, Li Dapeng, Yan Chun, Liu Anxiong, Yuan Yi
Department of Orthopaedics, Pingshan Traditional Chinese Medicine Hospital, Pingshan Sichuan, 645350, P.R.China.
Department of Orthopaedics, Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou Sichuan, 646000,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Apr 15;33(4):440-444. doi: 10.7507/1002-1892.201808077.
To investigate the feasibility and effectiveness of unexposed ulnar nerve medial elbow incision, open reduction and internal fixation of anatomical locking compression plate (LCP) for distal humerus fractures.
Fourteen patients with distal humerus fracture were treated between January 2014 and June 2017. There were 5 males and 9 females, aged 18-85 years (mean, 65.5 years). The causes of injury included falling from height in 12 cases and traffic accident in 2 cases, all were closed fractures. Fractures were classified according to the AO/Association for the Study of Internal Fixation (AO/ASIF): 3 cases of type A2, 2 cases of type A3, 4 cases of type B2, 2 cases of type C1, 2 cases of type C2, and 1 case of type C3; without ulnar nerve damage. The time from injury to operation was 4-15 days, with an average of 7 days. The type B2 fractures were treated with unexposed ulnar nerve elbow medial incision and anatomic LCP internal fixation, the rest patients were all treated with unexposed ulnar nerve medial plus conventional lateral approach and bilateral LCP internal fixation.
The operation time was 50-140 minutes (mean, 80 minutes), and the intraoperative blood loss was 20-200 mL (mean, 70 mL). There was no blood vessels or nerve damage during operation. All incisions healed by first intension, and no incision infection occurred. All the 14 cases were followed up 9-24 months (mean, 13 months). X-ray films showed that all fractures healed within 4 months without complications such as nonunion and osteomyelitis. No ulnar nerve injury, cubitus varus deformity, and ossifying myositis occurred during follow-up. At last follow-up, the elbow function was assessed by Mayo Elbow Performance score (MEPS), the results were excellent in 8 cases, good in 4 cases, fair in 1 case, and poor in 1 case (type C3 fracture), with the excellent and good rate of 85.7%.
The unexposed ulnar nerve medial elbow incision can be used effectively to reduct the fracture, and it is not prone to ulnar nerve injury. Combined with the lateral approach to treat the distal humerus fracture, which has the advantages of short operation time, few trauma, little bleeding, and reliable effectiveness.
探讨经尺神经未显露的肘内侧切口、解剖型锁定加压钢板（LCP）切开复位内固定治疗肱骨远端骨折的可行性及有效性。
2014年1月至2017年6月收治14例肱骨远端骨折患者。男5例，女9例，年龄18 - 85岁（平均65.5岁）。受伤原因包括高处坠落12例，交通事故2例，均为闭合性骨折。骨折按AO/国际内固定研究学会（AO/ASIF）分型：A2型3例，A3型2例，B2型4例，C1型2例，C2型2例，C3型1例；均无尺神经损伤。受伤至手术时间为4 - 15天，平均7天。B2型骨折采用经尺神经未显露的肘内侧切口及解剖型LCP内固定治疗，其余患者均采用经尺神经未显露的肘内侧联合传统外侧入路及双侧LCP内固定治疗。
手术时间为50 - 140分钟（平均80分钟），术中出血量为20 - 200毫升（平均70毫升）。术中无血管、神经损伤。所有切口均一期愈合，无切口感染发生。14例均获随访，时间9 - 24个月（平均13个月）。X线片显示所有骨折均在4个月内愈合，无骨不连、骨髓炎等并发症。随访期间无尺神经损伤、肘内翻畸形及骨化性肌炎发生。末次随访时，采用Mayo肘关节功能评分（MEPS）评估肘关节功能，结果优8例，良4例，可1例，差1例（C3型骨折），优良率为85.7%。
经尺神经未显露的肘内侧切口能有效用于骨折复位，且不易发生尺神经损伤。联合外侧入路治疗肱骨远端骨折，具有手术时间短、创伤小、出血少、疗效可靠等优点。
