Winek Nathan C, Rubinstein Aaron J, Hwang Minju, Amadio Joseph M, Hammarstedt Jon E, Regal Steven
Allegheny Health Network Department of Orthopedics, Pittsburgh, PA, USA.
Allegheny Health Network Department of Orthopedics, Pittsburgh, PA, USA.
J Shoulder Elbow Surg. 2023 Feb;32(2):401-406. doi: 10.1016/j.jse.2022.08.025. Epub 2022 Oct 4.
Distal humerus fractures are common and can be difficult to treat. No one approach to the distal humerus has been shown to be superior to another; however, the olecranon osteotomy remains the gold standard for complex, intra-articular fractures. Understanding the percent of articular exposure with approaches to the distal humerus is important for success. The goal of this study is to show the percent of articular exposure of the triceps fascial tongue approach as compared with the olecranon osteotomy.
Twelve fresh frozen cadavers were separated randomly into 2 groups of 6 each. The first group of 6 specimens was allocated to the triceps fascial tongue approaches with the collaterals maintained and with the collaterals released off the ulna and elbow dislocated. The second group of 6 was allocated to the triceps fascial tongue approach while maintaining the collaterals followed by an olecranon osteotomy. The articular exposure was marked after performing each approach, and the percent of articular exposure was quantified by using 3D scanning. Standard deviations were calculated for each.
The average percent visualization of the distal humerus articular surface in the fascial tongue approach while maintaining the collaterals was 36% in the first cohort and 37% in the second cohort with a standard deviation of 5% in both cohorts. The average percent of the distal humerus articular surface exposed in the fascial tongue approach with the collaterals released off the ulna and elbow dislocated was 85.09% with a standard deviation of 4%. The average percent of the distal humerus articular surface exposed in the olecranon osteotomy group was 57.9% with a standard deviation of 5%.
The triceps fascial tongue approach allows for visualization of about one-third of the joint, which may be adequate for many intra-articular distal humerus fractures. For added exposure of the articular surface, the collaterals may be elevated from the ulna and the elbow dislocated allowing for a substantial increase in percent of articular exposure compared with the collateral retaining fascial tongue approach and the olecranon osteotomy.
肱骨远端骨折很常见且治疗难度较大。目前尚无一种治疗肱骨远端的方法被证明优于其他方法；然而，鹰嘴截骨术仍是治疗复杂关节内骨折的金标准。了解肱骨远端手术入路的关节面暴露百分比对手术成功至关重要。本研究的目的是展示与鹰嘴截骨术相比，肱三头肌筋膜舌形入路的关节面暴露百分比。
将12具新鲜冷冻尸体随机分为两组，每组6具。第一组6个标本采用保留侧副韧带的肱三头肌筋膜舌形入路，以及将侧副韧带从尺骨上松解并使肘关节脱位的肱三头肌筋膜舌形入路。第二组6个标本采用保留侧副韧带的肱三头肌筋膜舌形入路，随后进行鹰嘴截骨术。每种入路完成后标记关节面暴露情况，并使用三维扫描对关节面暴露百分比进行量化。计算每组的标准差。
在第一组中，保留侧副韧带的筋膜舌形入路中肱骨远端关节面的平均可视化百分比为36%，第二组为37%，两组的标准差均为5%。将侧副韧带从尺骨上松解并使肘关节脱位的筋膜舌形入路中，肱骨远端关节面的平均暴露百分比为85.09%，标准差为4%。鹰嘴截骨术组中肱骨远端关节面的平均暴露百分比为57.9%，标准差为5%。
肱三头肌筋膜舌形入路可显露约三分之一的关节，这对于许多关节内肱骨远端骨折可能足够。为增加关节面暴露，可将侧副韧带从尺骨上掀起并使肘关节脱位，与保留侧副韧带的筋膜舌形入路和鹰嘴截骨术相比，关节面暴露百分比可大幅增加。
