Wei Libiao, Xu Haitao, An Zhiquan
Huadong Hospital Affiliated to Fudan University, Shanghai-China.
Department of Traumatic Orthopedics Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai-China.
Ulus Travma Acil Cerrahi Derg. 2020 Jul;26(4):586-592. doi: 10.14744/tjtes.2019.69486.
This research aimed to evaluate the functional outcomes of intra-articular distal humeral fractures treated through a combined medial-lateral approach and comparing with olecranon osteotomy simultaneously.
In this study, 62 distal humeral fractures patients were assessed retrospectively. The olecranon osteotomy was used in 30 cases (14 males, 16 females) and combined medial-lateral in 32 cases (15 males, 17 females). The outcomes of function were assessed by the Mayo Elbow Performance Score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score. The follow-up time was 15.4±3.5 months (range 10-24 months) for a combined medial-lateral group and 14.6±2.6 months (range 10-20 months) for olecranon osteotomy.
Level, retrospective study.
The flexion-extension of elbows was 115.3°±16.1° in the combined medial-lateral group, and the olecranon osteotomy group was 110.1°±15.2°. A significant difference was observed between the two groups for flexion-extension of the elbows (p=0.041). Pronation-supination of the forearms had a significant difference (p=0.025) between the combined medial-lateral group (160.6°±7.2°) and the olecranon osteotomy group (154.1°±9.3°). Mean MEPS, DASH, excellent and good rate and complication rate for combined medial-lateral approaches were 88.6±6.9 points, 9.8±6.6 points, 90.6% and 9.4%, respectively. Significant differences were not noted between the two groups for mean MEPS, DASH scores and excellent and good rate (p=0.594, p=0.505, p=0.934, respectively) except complication rate (p=0.005).
The combined medial-lateral approach is successful approach in the treatment of intra-articular distal humeral fractures (especially type C1 and C2) that provides better outcomes for the motion of the elbow, bleeding volume in surgery and complications than olecranon osteotomy.
本研究旨在评估经内外侧联合入路治疗肱骨远端关节内骨折的功能结果，并与同时行鹰嘴截骨术进行比较。
本研究对62例肱骨远端骨折患者进行回顾性评估。30例（男14例，女16例）采用鹰嘴截骨术，32例（男15例，女17例）采用内外侧联合入路。通过梅奥肘关节功能评分（MEPS）和上肢、肩部和手部功能障碍（DASH）问卷评分评估功能结果。内外侧联合入路组随访时间为15.4±3.5个月（范围10 - 24个月），鹰嘴截骨术组为14.6±2.6个月（范围10 - 20个月）。
回顾性研究。
内外侧联合入路组肘关节屈伸角度为115.3°±16.1°，鹰嘴截骨术组为110.1°±15.2°。两组肘关节屈伸角度差异有统计学意义（p = 0.041）。内外侧联合入路组（160.6°±7.2°）与鹰嘴截骨术组（154.1°±9.3°）前臂旋前旋后角度差异有统计学意义（p = 0.025）。内外侧联合入路组的平均MEPS、DASH评分、优良率及并发症发生率分别为88.6±6.9分、9.8±6.6分、90.6%和9.4%。除并发症发生率外，两组平均MEPS、DASH评分及优良率差异无统计学意义（分别为p = 0.594、p = 0.505、p = 0.934）（p = 0.005）。
内外侧联合入路是治疗肱骨远端关节内骨折（尤其是C1和C2型）的成功方法，与鹰嘴截骨术相比，在肘关节活动、手术出血量及并发症方面效果更好。
