鹰嘴截骨术后复杂肱骨远端骨折的双螺钉固定与张力带固定的比较。

Comparison of double screw fixation versus tension-band fixation after olecranon osteotomy for complex distal humerus fractures.

机构信息

Service de chirurgie orthopédique, CHU d'Angers, 4, rue Larrey, 49000 Angers, France.

出版信息

Orthop Traumatol Surg Res. 2021 Apr;107(2):102641. doi: 10.1016/j.otsr.2020.02.022. Epub 2020 Oct 29.

DOI:10.1016/j.otsr.2020.02.022

PMID:33129752

Abstract

INTRODUCTION

Supra- and intercondylar elbow fractures are surgically challenging given the intra-articular comminution. Various surgical approaches have been described. Among these-olecranon osteotomy-provides optimal joint exposure but is associated with several complications. Tension band wiring (TBW) is the most commonly used fixation method. We hypothesized that double screw fixation would lead to fewer surgical revisions than TBW (all causes included) after olecranon osteotomy.

METHODS

We carried out a single-center retrospective study of 39 patients, treated between January 2007 and April 2016, for a supra- or intercondylar elbow fracture using the transolecranon exposure. There were 34 type C fractures (13 C1, 6 C2 and 15 C3), 3 type B fractures and 2 type A fractures, based on the AO classification. Fourteen patients received double screw fixation and 25 received TBW. The primary outcome measure was the number of surgical revisions, regardless of cause. Secondary outcome measures were the number of surgical revisions for olecranon nonunion, fixation failure or fixation device removal due to pain.

RESULTS

There were significantly more surgical revisions in the TBW group than in the double screw fixation group: 3 (21%) versus 14 (56%) (p=0.049, Fisher test). The three main reasons for revision in the TBW and double screw fixation groups were removal of the fixation device due to soft tissue impingement (11 [44%] versus 2 [14%]; p=0.08), failure of the olecranon fixation (6 [24%] versus 1 [7%] p=0.38), and olecranon nonunion (4 [16%] versus 0 [0%] p=0.27).

DISCUSSION

There are no published studies on the outcomes of this surgical technique. The posterior transolecranon approach provides the best exposure at the elbow joint. TBW fixation is associated with multiple complications. Double screw fixation for olecranon fractures yields good clinical and radiological outcomes.

CONCLUSION

Based on our findings, double screw fixation of the olecranon results in fewer surgical revisions (all causes combined) than TBW in supra- and intercondylar elbow fractures operated by a transolecranon approach.

LEVEL OF EVIDENCE

IV.

摘要

简介

由于关节内粉碎，肘上和肘间骨折的手术治疗极具挑战性。已经描述了各种手术入路。其中，尺骨鹰嘴截骨术提供了最佳的关节显露，但也与许多并发症相关。张力带钢丝固定（TBW）是最常用的固定方法。我们假设，与 TBW（包括所有原因）相比，尺骨鹰嘴截骨术后双螺钉固定导致的手术翻修更少。

方法

我们进行了一项单中心回顾性研究，纳入了 2007 年 1 月至 2016 年 4 月间采用经尺骨鹰嘴入路治疗的 39 例肘上或肘间骨折患者。AO 分类中，34 例为 C 型骨折（13 例 C1 型，6 例 C2 型和 15 例 C3 型），3 例 B 型骨折和 2 例 A 型骨折。14 例患者接受双螺钉固定，25 例患者接受 TBW。主要结局指标为无论病因如何，手术翻修的数量。次要结局指标为尺骨鹰嘴骨不连、固定失败或因疼痛而去除固定装置的手术翻修数量。

结果

TBW 组的手术翻修明显多于双螺钉固定组：3 例（21%）与 14 例（56%）（p=0.049，Fisher 检验）。TBW 组和双螺钉固定组中，翻修的三个主要原因是固定装置因软组织撞击而去除（11 例[44%]与 2 例[14%]；p=0.08），尺骨鹰嘴固定失败（6 例[24%]与 1 例[7%]；p=0.38），以及尺骨鹰嘴骨不连（4 例[16%]与 0 例[0%]；p=0.27）。