| Objective According to the different operative approaches,this paper explores the therapeutic effects of the "V" shaped osteotomy approach of ulna olecranon and the two side approach of triceps of humerus(Alonso-Llames)approach in the treatment of type C fracture of distal humerus in adults,and comprehensively compares the differences between the two approaches,so as to guide the clinical work more clearly.Methods According to our study,33 cases of type C fracture of distal humerus in adults were analyzed retrospectively from October 2016 to October 2017 in the first people’s Hospital of Hefei(the Third Affiliated Hospital of Anhui Medical University)through the "V" shaped osteotomy approach of ulna olecranon and the bilateral approach of triceps brachii.Among them,there were 16 males and 17 females,with an average age of 47.27 years.According to AO classification criteria,there were 13 cases of C1,11 of C2 and 9 of C3.According to the set grouping,the number of cases in osteotomy group is 15,the age is between 23 and 65 years old,the average age is 46.73 years old,the number of cases in bilateral approach group is 18,the age is from 23 to 71 years old,the average age is 47.72 years old.The intraoperative blood loss(ML),operative time(min),time to achieve bony healing(weeks),incision drainage(ML),postoperative functional score(MEPS),postoperative mobility(ROM)and postoperative complications were compared between osteotomy group and bilateral approach group.Results We have obtained complete follow-up data for all the eligible cases,and the follow-up time is 12 to 18 months.None of the surgical cases included in the study had complications of incision infection,all of them met the first stage healing standard,and no loosening or failure of internal fixation was found.Comparing the operation time of the two groups,we found that the average operation time of V-shaped osteotomy group was 146.67 ± 26.71(min),while that of Alonso-Llames group was 117.00 ± 29.97(min).It is not difficult to see that the operation time of Olecranon group was relatively longer,and the difference was statistically significant(P < 0.05)。 The bleeding volume of V-shaped osteotomy of olecranon was 190.33 ± 43.36(ML)and the postoperative incision drainage volume was 111.33 ± 21.25(ML),which was more than that of bilateral approach group(159.17 ± 40.77(ML)and 76.67 ± 22.10(ML))(P <0.05).In the comparison of complications,there was one case of ulnar nerve injury in osteotomy group(with numbness of little finger after operation)and one case of delayed traumatic arthritis in osteotomy group(P < 0.05).The bone healing time of the two groups was 14.47 ± 1.51 weeks in the group of foot osteotomy and 14.22 ± 1.31 weeks in the group of lateral approach of triceps.There was no significant difference between them(P < 0.05).There was no significant difference in ROM of elbow joint one year after operation(P > 0.05).In MEPs of elbow joint one year after operation,the excellent rate of osteotomy group was 73.3%,the excellent rate of bilateral group was 72.2%,and the effect was similar(P > 0.05).Conclusion Based on our research and clinical experience,we found that the olecranon "V" of ulna is better than the surgical approach on both sides of triceps brachii However,it will take longer operation time and bring more trauma.It is more difficult for patients to accept it in heart,and it is more suitable for C3 Type with more complex fracture.However,the exposure of fracture end and elbow joint surface in the operation is slightly worse than that in the olecranon osteotomy group,which is more suitable for C1 and C2 fractures. |
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