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  • Title: [Incidence and risk factors of ulnar nerve dysfunction after open reduction and internal fixation of humeral intercondylar fractures].
    Author: Liu G, Chen C, Li T, Zha YJ, Gong MQ, Jiang XY.
    Journal: Zhonghua Yi Xue Za Zhi; 2019 Nov 19; 99(43):3408-3412. PubMed ID: 31752468.
    Abstract:
    Objective: To investigate the incidence and related risk factors of ulnar nerve dysfunction after open reduction and internal fixation of humeral intercondylar fractures. Methods: A total of 168 patients who underwent open reduction and plate and screw fixation of a humeral intercondylar fracture between January 2013 and May 2017 were retrospectively analyzed. There were 85 males and 83 females, aged from 14 to 77 years with a mean age of (43±17) years. Diagnosis of ulnar neuropathy was defined as documentation of sensory and motor dysfunction of the ulnar nerve in the medical record. The explanatory (independent) variables included age, gender, injury type, AO typing, time from injury to surgery, surgery approach, plates fixation methods and whether the nerve was transposed. Univariate and multivariate analyses were performed to determine risk factors associated with postoperative ulnar nerve dysfunction. Results: Acute injury-related ulnar nerve neuropathy was diagnosed in 12(7.1%) of 168 patients. Among the other 156 patients without preoperative ulnar nerve neuropathy,the total postoperative ulnar neuropathy was found in 52 patients (33.3%), and in 26(16.7%) at the final follow-up, according to the McGowan grades system; 23(88.5%) of 26 patients were clinically graded as grade 1, and 3(11.5%) were graded as grade 2. Multivariate logistic analysis showed that triceps sparing approach (OR=2.639, P=0.039) and parallel double plate fixation (OR=3.089, P=0.046) were associated with a risk of postoperative ulnar nerve dysfunction. Conclusion: There is a substantial incidence of postoperative ulnar nerve dysfunction after open reduction and plate and screw fixation of humeral intercondylar fracture, postoperative ulnar neuropathy may occur from the time of injury through the long-term follow-up period, triceps sparing approach and parallel double plate fixation are the risk factors for ulnar neuropathy. 目的： 探讨肱骨髁间骨折切开复位内固定术后尺神经功能障碍发生情况及相关危险因素分析。 方法： 回顾性分析2013年1月至2017年5月于北京积水潭医院创伤骨科进行肱骨髁间骨折切开复位内固定的168例患者的临床资料，其中男85例，女83例，年龄14~77（43±17）岁。记录患者的年龄、性别、骨折分型、受伤到手术时间、手术入路、钢板固定放置方式、尺神经处理方式及手术时长等资料。术后随访并统计术后尺神经功能障碍发生情况，根据术后是否出现尺神经麻痹症状分为尺神经功能障碍组及无尺神经功能障碍组，应用单因素分析及多因素Logistic回归分析筛选肱骨髁间骨折术后出现尺神经功能障碍的可能危险因素。 结果： 168例患者中共12例（7.1%）在外伤后手术前即刻出现尺神经麻痹症状；在术前无尺神经麻痹症状的156例患者中，52例（33.3%）在术后出现过尺神经麻痹症状，26例（16.7%）在末次随访时仍残留尺神经功能障碍，其中McGowan 1级23例（88.5%）、McGowan 2级3例（11.5%）。多因素相关分析发现钢板放置方式中钢板平行放置及手术入路中肱三头肌两侧入路为术后发生尺神经功能障碍的相关危险因素（OR=3.089、2.639，P=0.046、0.039）。 结论： 肱骨髁间骨折切开复位内固定术后尺神经功能障碍的发生率较高，且其出现贯穿于整个病程中，肱三头肌两侧入路及双钢板平行放置为术后发生尺神经功能障碍的危险因素。.
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