Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
Department of Trauma Surgery, Yanzhou District People's Hospital, Jining, Shandong, China.
BMC Surg. 2022 Jul 4;22(1):257. doi: 10.1186/s12893-022-01706-9.
Existing approaches for treating elbow fractures include lateral, medial, anterior and posterior approaches, though the anterior approach is often not chosen by surgeons to avoid damage to important nerves and blood vessels. However, the anterior approach has unique advantages. The purpose of this study was to report outcomes of 38 patients with coronal plane elbow fractures treated through the anterior approach.
We retrospectively analyzed 38 cases of coronal plane elbow fracture treated through an anterior approach at our institution between March 2015 and July 2019. The length of the surgical incision, operation time, and postoperative complications were recorded. The range of flexion, extension, and rotation of the affected elbow and the healthy elbow were collected at follow-up. Functional outcomes were evaluated using the Mayo Elbow Function Score (MEPS).
All 38 patients were followed up for a mean of 21.26 months (range 12-36 months). Intraoperatively, the mean surgical incision length was 8 ± 2 cm and the mean operative time was 123 ± 59 min. At the final follow-up, solid osseous union was confirmed for all coronal plane elbow fractures. The mean elbow flexion arc was 129 ± 7°, and the extension arc was 9 ± 6°. The mean pronation arc was 83 ± 3°, and the supination arc was 80 ± 3°. The mean MEPS was 90 ± 8 points, with 18 excellent cases and 20 cases of excellent and good results, respectively. In 31 cases, there was no significant difference in elbow extension, flexion, or pronation between the single-fracture and healthy elbows (P > 0.05), though the arc of supination was slightly worse than that of the healthy elbow (P < 0.05). VAS pain scores before the operation, at three months after the operation, and during follow-up were compared, and pain was significantly reduced after treatment (P < 0.05). Two patients experienced transient postoperative median nerve paralysis, from which they recovered within three months. One patient had mild heterotopic ossification and was not treated because it did not affect the function of the elbow joint. All patients returned to work and were satisfied with the treatment.
The anterior approach has the benefits of simplicity, safety, minimal invasiveness, excellent exposure, and satisfactory prognosis for coronal plane elbow fracture.
治疗肘部骨折的方法包括外侧入路、内侧入路、前入路和后入路，但外科医生通常不选择前入路，以避免损伤重要的神经和血管。然而，前入路具有独特的优势。本研究旨在报告通过前入路治疗冠状面肘部骨折的 38 例患者的结果。
我们回顾性分析了 2015 年 3 月至 2019 年 7 月期间我院通过前入路治疗的 38 例冠状面肘部骨折病例。记录手术切口长度、手术时间和术后并发症。随访时采集患侧和健侧肘部屈伸和旋转范围。采用 Mayo 肘部功能评分（MEPS）评估功能结果。
所有 38 例患者均获得平均 21.26 个月（12-36 个月）随访。术中手术切口平均长度为 8±2cm，手术时间平均为 123±59min。末次随访时，所有冠状面肘部骨折均确认骨性愈合。肘部平均屈曲弧为 129±7°，伸展弧为 9±6°。平均旋前弧为 83±3°，旋后弧为 80±3°。平均 MEPS 为 90±8 分，其中优 18 例，良 20 例。31 例患者中，单骨折侧与健侧的肘部伸展、屈曲或旋前无显著差异（P>0.05），但旋后弧稍差于健侧（P<0.05）。比较术前、术后 3 个月及随访时的 VAS 疼痛评分，治疗后疼痛明显减轻（P<0.05）。2 例患者术后出现短暂性正中神经麻痹，均在 3 个月内恢复。1 例患者出现轻度异位骨化，未予治疗，因其不影响肘关节功能。所有患者均恢复工作并对治疗满意。
前入路治疗冠状面肘部骨折具有操作简单、安全、微创、显露极佳、预后满意等优点。
