Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus
Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus
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DOI：
10.1097/00005131-200408000-00010
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发表时间：
2004-08-01
影响因子：
2.3
通讯作者：
Jupiter, JB
中科院分区：
文献类型：
--
作者：
Ring, D;Gulotta, L;Jupiter, JB
虽然鹰嘴截骨术能提供良好的肱骨远端暴露，但由于报告显示有许多并发症，因此限制了对该入路的热情。有人建议，创建和修复鹰嘴截骨术的特定技术可能有助于减少并发症。本文描述了一种尺骨鹰嘴截骨术，采用顶点、远端、人字形截骨，克氏针从冠状突远端的前尺骨皮质中穿出，弯曲180度并在近端打入尺骨鹰嘴，以及两根22号8字形不锈钢张力针。一名外科医生在45名连续患者中使用该技术暴露肱骨远端骨折（16名患者）或骨不连（29名患者）。1例患者过早恢复活动，钢丝固定松动，需要再次手术进行尺骨钢板固定。其余44例截骨术（98%）在6个月内愈合，对线良好。愈合前，没有断裂或移位的导丝。12名患者（27%）取出了用于修复鹰嘴的导丝：6名患者的症状与导丝相关（13%）; 1名患者的症状与脓毒性鹰嘴滑囊炎有关，5名患者在另一次手术时取出（4名患者的肘关节囊松解术和1名患者的肌下尺神经移位术）。鹰嘴截骨术可用于暴露肱骨远端，当使用特定技术时，并发症发生率较低。
Although olecranon osteotomy provides excellent exposure of the distal humerus, enthusiasm for this approach has been limited by reports suggesting numerous complications. It has been suggested that specific techniques for creating and repairing an olecranon osteotomy may help limit complications. This paper describes a technique for olecranon osteotomy using an apex, distal, chevron-shaped osteotomy, Kirschner wires directed out the anterior ulnar cortex distal to the coronoid process and bent 180degrees and impacted into the olecranon proximally, and two 22- gauge, figure-of-eight, stainless steel tension wires. A single surgeon used this technique for exposure of a fracture (16 patients) or nonunion (29 patients) of the distal humerus in 45 consecutive patients. One patient returned to activity too soon, had loosening of the wire fixation, and required a second operation for plate fixation of the ulna. The remaining 44 osteotomies (98%) healed with good alignment within 6 months. There were no broken or migrated wires prior to healing. Twelve patients (27%) had removal of the wires used to repair the olecranon: in 6 patients, this was for symptoms related to the wires (13%); 1 for septic olecranon bursitis, and 5 at the time of another procedure (elbow capsular release in 4 patients and submuscular ulnar nerve transposition in 1). Olecranon osteotomy can be used for exposure of the distal humerus with a low rate of complications when specific techniques are used.