【摘要】：目的:比較前外側(cè)入路及外側(cè)入路切開復(fù)位內(nèi)固定治療肱骨遠(yuǎn)端冠狀面剪切骨折的效果,探討兩種手術(shù)方法的利弊及適應(yīng)證。方法:回顧性分析北京積水潭醫(yī)院2006年9月至2014年7月的10例肱骨遠(yuǎn)端冠狀面剪切骨折的切開復(fù)位內(nèi)固定病例,以Dubberley方法進(jìn)行骨折的分型,采用前外側(cè)入路為A組,外側(cè)入路為B組,記錄術(shù)后并發(fā)癥發(fā)生情況,Mayo評(píng)分評(píng)價(jià)最終臨床結(jié)果。結(jié)果:A組5例,術(shù)前分型ⅠA型1例,ⅡA型1例,ⅢA型1例,ⅢB型2例,均用自前向后埋頭螺釘固定骨折塊,對(duì)滑車橈側(cè)骨折塊也以螺釘單獨(dú)固定,術(shù)后Mayo評(píng)分平均82分,4例需再次手術(shù),2例因螺釘刺激行內(nèi)固定物取出,1例肘關(guān)節(jié)僵硬,1例內(nèi)固定失效,1例發(fā)生一過(guò)性橈神經(jīng)損傷;B組5例,術(shù)前分型ⅠA型和ⅠB型各1例,ⅡA型3例,術(shù)后Mayo評(píng)分平均91分,僅1例發(fā)生內(nèi)固定失效,肘關(guān)節(jié)不穩(wěn)定需再次手術(shù)。結(jié)論:外側(cè)入路較好,但對(duì)滑車部位骨折的處理略顯不足,術(shù)中要注意外側(cè)副韌帶(lateral collateral ligament,LCL)的保護(hù)及修復(fù)。前外側(cè)入路并發(fā)癥發(fā)生較多,優(yōu)點(diǎn)是對(duì)滑車部位的顯露較直接,但因不脫位,肘關(guān)節(jié)顯露范圍較小,對(duì)于肱骨遠(yuǎn)端的壓縮骨折顯露及固定欠佳。
[Abstract]:Objective: to compare the effect of anterior lateral approach and lateral approach open reduction and internal fixation in the treatment of coronal shear fracture of distal humerus, and to explore the advantages, disadvantages and indications of the two surgical methods. Methods: from September 2006 to July 2014 in Beijing Jishuitan Hospital, 10 cases of distal humerus coronal shear fracture were treated with open reduction and internal fixation. Dubberley method was used to classify the fracture. The anterior lateral approach was used as group A and the lateral approach was used as group B. the postoperative complications were recorded and the final clinical results were evaluated by Mayo score. Results: in group A, there were 1 case of preoperative classification, 1 case of type 鈪，

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