【摘要】：目的探討前外側(cè)入路結(jié)合Kocher入路治療肱骨遠(yuǎn)端冠狀面骨折的療效。方法回顧性分析2008年3月—2014年2月由浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院收治的肱骨遠(yuǎn)端冠狀面骨折患者14例,按Dubberley分型:2A型7例,2B型1例,3A型4例,3B型2例。所有患者均采用前外側(cè)入路結(jié)合Kocher入路,術(shù)中以Bold螺釘固定。常規(guī)于術(shù)后第1、2、3、6、9、12、18個(gè)月進(jìn)行隨訪,根據(jù)患者X線攝片觀察骨折愈合情況,根據(jù)Mayo肘關(guān)節(jié)功能評(píng)分標(biāo)準(zhǔn)進(jìn)行肘關(guān)節(jié)功能評(píng)分,于上肢處于中立位時(shí)測(cè)定肘關(guān)節(jié)活動(dòng)度(屈肘和伸肘的角度)。結(jié)果所有患者均順利完成手術(shù),術(shù)后第2天即可進(jìn)行輔助性主動(dòng)功能鍛煉。本組14例患者中有2例失訪,余均獲隨訪。隨訪時(shí)間10~22個(gè)月,中位隨訪時(shí)間為14.2個(gè)月。Mayo肘關(guān)節(jié)功能評(píng)分55~100分,中位肘關(guān)節(jié)功能評(píng)分為87.5分。肘關(guān)節(jié)活動(dòng)度:伸肘角度0~22°,中位伸肘角度為8°;屈肘角度95~135°,中位屈肘角度為122°。所有患者術(shù)中骨折均解剖復(fù)位后固定,術(shù)后均為骨性愈合,愈合時(shí)間為術(shù)后10~16周,中位愈合時(shí)間為術(shù)后11.4周。術(shù)后無(wú)1例患者發(fā)生傷口感染和血管、神經(jīng)損傷,1例患者發(fā)生創(chuàng)傷性關(guān)節(jié)炎,3例發(fā)生異位骨化。結(jié)論前外側(cè)入路結(jié)合Kocher入路治療肱骨遠(yuǎn)端冠狀面骨折,有利于術(shù)中解剖復(fù)位、堅(jiān)強(qiáng)固定,術(shù)后早期患者即可進(jìn)行功能鍛煉。
[Abstract]:Objective to evaluate the efficacy of anterolateral approach combined with Kocher approach in the treatment of distal humeral coronal fractures. Methods from March 2008 to February 2014, 14 patients with distal coronal fracture of humerus treated by the second affiliated Hospital of Zhejiang University Medical College were retrospectively analyzed. According to Dubberley classification, there were 7 cases of type 2A, 1 case of type 2B, 4 cases of type 3A and 2 cases of type 3B. All patients were treated with anterolateral approach combined with Kocher approach and fixed with Bold screw during operation. The patients were followed up for 18 months. The fracture healing was observed by X-ray, and the function of elbow joint was scored according to Mayo elbow function scoring standard. The elbow motion (the angle of elbow flexion and extension) was measured when the upper limb was in neutral position. Results all the patients completed the operation successfully, and on the second day after operation, auxiliary active function exercise was performed. Of the 14 cases, 2 cases lost their visits and the rest were followed up. The median follow-up time was 14.2 months. The Mayo elbow function score was 55 ~ 100 and the median elbow function score was 87.5. The range of motion of elbow joint: the angle of elbow extension was 22 擄, the angle of elbow extension was 8 擄, the angle of elbow flexion was 95 擄and 135 擄, and the angle of elbow flexion was 122 擄. All the patients were fixed after anatomic reduction and fixation. The healing time was 1016 weeks and the median healing time was 11.4 weeks. There was no wound infection, vascular and nerve injury in 1 case, traumatic arthritis in 1 case, ectopic ossification in 3 cases. Conclusion anterolateral approach combined with Kocher approach for the treatment of distal humeral coronal fracture is beneficial to anatomical reduction and firm fixation during operation and early postoperative functional exercise.
【作者單位】： 浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院骨科;武警浙江省總隊(duì)嘉興醫(yī)院骨四科;
【分類(lèi)號(hào)】：R687.3

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