背景:肱骨远端髁间骨折的首选治疗方法是切开复位内固定。虽然后路入路有共识,已经开发了几种后路。关于哪种方法最好,尚有争议。
目的:比较肱三头肌反位椎弓根(TRAP)和尺骨鹰嘴截骨入路治疗肱骨远端髁间骨折的内固定。
方法:总共,40例Arbeitsgemeinschaftfür骨合成/C型内固定研究的关联,关闭,包括GustiloI型肱骨髁间骨折。患者的年龄从18岁到70岁不等。将患者随机分为两组:TRAP组和尺骨鹰嘴截骨组。各20例。所有人都在6周进行了随访,3个月,6个月,和12个月。根据屈伸弧测量功能结果,手臂的残疾,肩和手的评分,和梅奥弯头表演得分。
结果:TRAP组平均年龄为43.2岁,尺骨鹰嘴截骨组平均年龄为37.5岁。TRAP组的平均手术时间和平均住院时间明显高于尺骨鹰嘴截骨组(119.5vs111.5min和9.85vs5.45d,分别)。屈伸的平均弧度,手臂的残疾,肩和手的评分,在12个月的随访中,两组的Mayo肘关节性能评分具有可比性,没有任何显着差异(分别为107.0vs106.2、18.3vs15.7和84.2vs86.2)。两组的尺骨感觉异常和浅表感染具有可比性(2例vs3例,3例vs2例,分别)。尺骨鹰嘴截骨组的硬件突出率明显更高,主要是由于张力带接线。
结论:两种方法是等效的,但是需要进一步的研究,包括更多的受试者和更长的研究时间,以证明一种方法比另一种方法的益处。
BACKGROUND: 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.
OBJECTIVE: To compare triceps reflecting anconeus pedicle (TRAP) and olecranon
osteotomy approaches for internal fixation of distal humeral intercondylar fracture.
METHODS: 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.
RESULTS: 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 vs 111.5 min and 9.85 vs 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 vs 106.2, 18.3 vs 15.7, and 84.2 vs 86.2, respectively). Ulnar paresthesia and superficial infections were comparable in both groups (2 cases vs 3 cases and 3 cases vs 2 cases, respectively). Hardware prominence was significantly higher in the olecranon
osteotomy group, mostly due to tension band wiring.
CONCLUSIONS: 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.