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内外侧联合入路对肱骨远端关节面有效可视面积(2)
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摘要:真皮下灌注与氧张力、胶原沉积和随后的伤口愈合线性相关[7]。本研究显示肘后部真皮下血管结构缺失可能造成缺血性创面并发症,暗示该区域为手术干预
真皮下灌注与氧张力、胶原沉积和随后的伤口愈合线性相关[7]。本研究显示肘后部真皮下血管结构缺失可能造成缺血性创面并发症,暗示该区域为手术干预的高风险区。Wang 等[8]指出肘后部微循环绝大部分来源于局部软组织的血管供应,内外侧良好的血供并未形成良好的侧支循环供应肘后组织。因此,肘后部任何形式的软组织破坏均有可能导致后肘部皮肤缺血,增加伤口愈合并发症的风险[9]。内外侧联合入路虽然看似切口多,创伤大,但是该入路大多经肌间隙显露,无明显截骨等医源性损伤,同时该入路也可获得较好的关节面有效可视面积,有利于骨折复位及钢板固定,具有较大的临床使用价值[10]。
综上所述,内外侧联合入路治疗肱骨远端关节面骨折安全有效、术野清晰,便于骨折复位固定,值得临床广泛推广。
图1 肘关节局部血供及微循环显示情况
表1 内侧联合入路下关节面有效可视面积参数 标本1 标本2 标本3 标本4 标本5 标本6内侧可视关节面(cm2) 6.14 4.90 5.05 7.99 9.12 7.63外侧可视关节面(cm2) 6.89 4.14 4.68 7.96 9.16 7.51内外联合可视关节面(cm2) 10.99 6.71 7.36 8.85 12.61 8.79肱骨远端总体关节面(cm2) 22.39 14.33 15.71 20.27 26.38 18.67内侧/总体(%) 27.5 34.2 32.2 39.6 34.7 40.2外侧/总体(%) 30.8 28.9 29.9 39.8 34.2 40.8内外联合/总体(%) 49.1 46.7 46.9 43.7 47.8 47.1
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