Jamoh Kalom, Tonk Gyneshwar
Departamento de Ortopedia, ESIC-PGIMSR, Nova Deli, Índia.
Departamento de Ortopedia, LLRM Medical College, Meerut, Uttar Pradesh, Índia.
Rev Bras Ortop (Sao Paulo). 2022 Feb 9;57(2):301-307. doi: 10.1055/s-0041-1741444. eCollection 2022 Apr.
To choose an appropriate posterior approach for distal humerus fractures in adults. Fifty patients with distal humerus fractures were analyzed prospectively. The fractures were classified using the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO, Working Group for Bone Fusion Issues, in German/OTA) classification. The patients were divided into group A and group B. Olecranon osteotomy (the transolecranon approach) was performed in 30 patients, and the triceps-reflecting approach was used in 20 patients. The functional results were evaluated using the Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The average operative time was of 92.62 ± 8.73 minutes for group A, and of 78.63 ± 7.02 minutes for group B, ( < 0.01), and the average blood loss was of 222.78 ± 34.93 mL for group A, and of 121.61 ± 19.85 mL for group B, ( < 0.01), which were statistically significant. The mean scores on the MEPS and DASH of both groups were found to be insignificant. Complications like infection, neurapraxia and soft tissue irritation where observed more in group A. The triceps-reflecting approach results in a shorter operative time, a lower levels of blood loss, and a low rate of complications, and olecranon osteotomy provides better accuracy in terms of articular reduction. But there were no significant differences between the two groups regarding the functional outcome. Therefore, we have proposed a new classification that is a modification of the AO/OTA classification: type 1 includes AO grades 13A to C2 (B3 excluded); and type 2, AO 13C3. For type-1 fractures, the triceps-reflecting approach may be considered, and, for type-2 fractures, olecranon osteotomy.
选择合适的成人肱骨远端骨折后路手术方式。对50例肱骨远端骨折患者进行前瞻性分析。采用德国骨科内固定协会/骨科创伤协会（AO，德语为骨融合问题工作组/OTA）分类法对骨折进行分类。将患者分为A组和B组。30例患者采用鹰嘴截骨术（经鹰嘴入路），20例患者采用肱三头肌翻转入路。使用梅奥肘关节功能评分（MEPS）和上肢、肩部和手部功能障碍（DASH）问卷对功能结果进行评估。A组平均手术时间为92.62±8.73分钟，B组为78.63±7.02分钟（P<0.01）；A组平均失血量为222.78±34.93毫升，B组为121.61±19.85毫升（P<0.01），差异有统计学意义。两组MEPS和DASH的平均评分无显著差异。A组感染、神经失用和软组织刺激等并发症更为常见。肱三头肌翻转入路手术时间短、失血量少、并发症发生率低，鹰嘴截骨术在关节复位方面准确性更高。但两组在功能结局方面无显著差异。因此，我们提出了一种对AO/OTA分类法的改良新分类：1型包括AO 13A至C2级（排除B3级）；2型为AO 13C3级。对于1型骨折，可考虑采用肱三头肌翻转入路；对于2型骨折，可采用鹰嘴截骨术。
