Liu G, Chen C, Li T, Zha Y J, Gong M Q, Jiang X Y
Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China.
Zhonghua Yi Xue Za Zhi. 2019 Nov 19;99(43):3408-3412. doi: 10.3760/cma.j.issn.0376-2491.2019.43.011.
To investigate the incidence and related risk factors of ulnar nerve dysfunction after open reduction and internal fixation of humeral intercondylar fractures. A total of 168 patients who underwent open reduction and plate and screw fixation of a humeral intercondylar fracture between January 2013 and May 2017 were retrospectively analyzed. There were 85 males and 83 females, aged from 14 to 77 years with a mean age of (43±17) years. Diagnosis of ulnar neuropathy was defined as documentation of sensory and motor dysfunction of the ulnar nerve in the medical record. The explanatory (independent) variables included age, gender, injury type, AO typing, time from injury to surgery, surgery approach, plates fixation methods and whether the nerve was transposed. Univariate and multivariate analyses were performed to determine risk factors associated with postoperative ulnar nerve dysfunction. Acute injury-related ulnar nerve neuropathy was diagnosed in 12(7.1%) of 168 patients. Among the other 156 patients without preoperative ulnar nerve neuropathy,the total postoperative ulnar neuropathy was found in 52 patients (33.3%), and in 26(16.7%) at the final follow-up, according to the McGowan grades system; 23(88.5%) of 26 patients were clinically graded as grade 1, and 3(11.5%) were graded as grade 2. Multivariate logistic analysis showed that triceps sparing approach (2.639, 0.039) and parallel double plate fixation (3.089, 0.046) were associated with a risk of postoperative ulnar nerve dysfunction. There is a substantial incidence of postoperative ulnar nerve dysfunction after open reduction and plate and screw fixation of humeral intercondylar fracture, postoperative ulnar neuropathy may occur from the time of injury through the long-term follow-up period, triceps sparing approach and parallel double plate fixation are the risk factors for ulnar neuropathy.
探讨肱骨髁间骨折切开复位内固定术后尺神经功能障碍的发生率及相关危险因素。回顾性分析2013年1月至2017年5月期间168例接受肱骨髁间骨折切开复位钢板螺钉内固定术的患者。其中男性85例，女性83例，年龄14~77岁，平均年龄(43±17)岁。尺神经病变的诊断依据病历中尺神经感觉和运动功能障碍的记录。解释性（独立）变量包括年龄、性别、损伤类型、AO分型、受伤至手术时间、手术入路、钢板固定方式以及神经是否移位。进行单因素和多因素分析以确定与术后尺神经功能障碍相关的危险因素。168例患者中有12例(7.1%)诊断为急性损伤相关性尺神经病变。在其余156例术前无尺神经病变的患者中，根据McGowan分级系统，术后共有52例(33.3%)发生尺神经病变，末次随访时为26例(16.7%)；26例患者中有23例(88.5%)临床分级为1级，3例(11.5%)为2级。多因素logistic分析显示，保留肱三头肌入路(2.639, 0.039)和平行双钢板固定(3.089, 0.046)与术后尺神经功能障碍风险相关。肱骨髁间骨折切开复位钢板螺钉内固定术后尺神经功能障碍发生率较高，术后尺神经病变可在受伤后至长期随访期间发生，保留肱三头肌入路和平行双钢板固定是尺神经病变的危险因素。
