Ailani Rohit, Bhuyan Sanjeev Kumar, Prasad Brejesh Kumar, Kumar Amit, Dawani Namrata
Department of Orthopaedics, Lovee Shubh Hospital, Lucknow, Uttar Pradesh 226002, India.
Department of Orthopaedics, Gauhati Medical College, Guahati 781032, India.
World J Orthop. 2024 Jun 18;15(6):570-577. doi: 10.5312/wjo.v15.i6.570.
The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation. While there is consensus about the posterior approach, several posterior approaches have been developed. It is debatable as to which approach is best.
To compare triceps reflecting anconeus pedicle (TRAP) and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture.
In total, 40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C, closed, and Gustilo type I intercondylar humeral fractures were included. Patients ranged in age from 18 years to 70 years. The patients were randomized into two groups: TRAP group and olecranon osteotomy group, with 20 cases in each. All were followed up at 6 wk, 3 months, 6 months, and 12 months. Functional outcomes were measured in terms of flexion-extension arc, Disabilities of Arm, Shoulder and Hand score, and Mayo Elbow Performance Score.
The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group. The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group (119.5 111.5 min and 9.85 5.45 d, respectively). The mean arc of flexion-extension, Disabilities of Arm, Shoulder and Hand score, and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up (107.0 106.2, 18.3 15.7, and 84.2 86.2, respectively). Ulnar paresthesia and superficial infections were comparable in both groups (2 cases 3 cases and 3 cases 2 cases, respectively). Hardware prominence was significantly higher in the olecranon osteotomy group, mostly due to tension band wiring.
Both approaches were equivalent, but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.
肱骨髁间远端骨折的首选治疗方法是切开复位内固定。虽然对于后入路已达成共识，但已开发出多种后入路方法。哪种方法最佳仍存在争议。
比较肱三头肌翻转带蒂肘肌（TRAP）入路和尺骨鹰嘴截骨入路用于肱骨髁间远端骨折内固定的效果。
共纳入40例 Arbeitsgemeinschaft für Osteosynthesefragen/内固定研究协会C型、闭合性和 Gustilo I型肱骨髁间骨折患者。患者年龄在18岁至70岁之间。将患者随机分为两组：TRAP组和尺骨鹰嘴截骨组，每组20例。所有患者均在术后6周、3个月、6个月和12个月进行随访。通过屈伸弧、手臂、肩部和手部功能障碍评分以及梅奥肘关节功能评分来评估功能结果。
TRAP组的平均年龄为43.2岁，尺骨鹰嘴截骨组为37.5岁。TRAP组的平均手术时间和平均住院时间显著高于尺骨鹰嘴截骨组（分别为119.5 ± 111.5分钟和9.85 ± 5.45天）。在12个月随访时，两组的平均屈伸弧、手臂、肩部和手部功能障碍评分以及梅奥肘关节功能评分相当，无显著差异（分别为107.0 ± 106.2、18.3 ± 15.7和84.2 ± 86.2）。两组的尺骨感觉异常和浅表感染情况相当（分别为2例对3例和3例对2例）。尺骨鹰嘴截骨组的内固定物突出明显更高，主要是由于张力带钢丝固定。
两种入路效果相当，但需要进一步开展研究，纳入更多受试者并延长研究时间，以证明一种入路相对于另一种入路的优势。
