Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea.
Medicine (Baltimore). 2022 Aug 26;101(34):e30216. doi: 10.1097/MD.0000000000030289.
Surgical outcomes of the paratricipital approach (PT) and olecranon osteotomy (OO) for the treatment of distal humerus intra-articular fracture have been reported. However, there is no consensus regarding which approach is better in terms of functional outcomes and complications. This study aimed to compare the operation time, functional outcomes, and complications of OO and PT.
The databases of MEDLINE, Embase, and Cochrane Library were systematically searched for studies published before June 1, 2021. We performed synthetic analysis of the operation time, functional outcomes, and incidence of complication after the conduct of OO group or PT group in patients with distal humerus intra-articular fractures.
Five studies were included representing a total of 243 patients who underwent surgery for distal humerus intra-articular fractures. A pooled analysis showed that there was a longer operation time in the OO group compared with the PT group (mean difference [MD] = 13.32, 95% CI: 3.78-22.87; P = .006). There was no significant difference between the functional outcomes of the OO and PT groups (elbow flexion: MD = 2.4, 95% CI: -0.82 to 5.79, P = .14; elbow extension: MD = 0.36, 95% CI: -2.20 to 2.92, P = .78; elbow arc of motion: MD = 0.40, 95% CI: -4.05 to 4.84, P = .86; Mayo Elbow Performance score: MD = -1.37, 95% CI: -4.73 to 1.98, P = .42). The incidence of infection was significantly higher in the OO group compared with that of the PT group (odds ratio [OR] = 3.82, 95% CI: 1.03-14.16, P = .04). There was no significant difference between the 2 groups in terms of the heterotopic ossification and ulnar neuropathy (OR = 1.85, 95% CI: 0.51-6.71, P = .35 and OR = 2.74, 95% CI: 0.60-12.48, P = .19, respectively).
Since the choice of surgical approach does not influence outcomes, surgeons can base their choice of approach on the basis of their own experience and familiarity with the procedure and the need to visualize the entire articular surface in complex intra-articular fracture patterns.
已经有研究报道了经肱三头肌两侧入路（PT）和尺骨鹰嘴截骨入路（OO）治疗肱骨远端关节内骨折的手术结果。然而，在功能结果和并发症方面，哪种方法更好，目前尚无共识。本研究旨在比较 OO 和 PT 治疗肱骨远端关节内骨折的手术时间、功能结果和并发症。
系统检索 MEDLINE、Embase 和 Cochrane 图书馆数据库，检索时间截至 2021 年 6 月 1 日之前发表的研究。我们对接受肱骨远端关节内骨折手术的患者进行 OO 组或 PT 组的手术时间、功能结果和并发症发生率进行综合分析。
纳入了 5 项研究，共 243 例患者接受了肱骨远端关节内骨折手术。汇总分析显示，OO 组的手术时间明显长于 PT 组（均数差值 [MD] = 13.32，95%置信区间：3.78-22.87；P =.006）。OO 组和 PT 组的功能结果无显著差异（肘屈伸：MD = 2.4，95%置信区间：-0.82 至 5.79，P =.14；肘伸展：MD = 0.36，95%置信区间：-2.20 至 2.92，P =.78；肘活动范围：MD = 0.40，95%置信区间：-4.05 至 4.84，P =.86；Mayo 肘关节功能评分：MD = -1.37，95%置信区间：-4.73 至 1.98，P =.42）。OO 组感染的发生率明显高于 PT 组（比值比 [OR] = 3.82，95%置信区间：1.03-14.16，P =.04）。两组间异位骨化和尺神经病变的发生率无显著差异（OR = 1.85，95%置信区间：0.51-6.71，P =.35 和 OR = 2.74，95%置信区间：0.60-12.48，P =.19）。
由于手术入路的选择并不影响结果，因此外科医生可以根据自己的经验、对手术程序的熟悉程度以及是否需要可视化复杂关节内骨折模式下的整个关节面来选择手术入路。
