目的 分析平行加压钢板内固定治疗肱骨远端C型骨折的临床疗效。方法 回顾分析2007-06至2014-08收治的肱骨远端C型骨折65例资料。按照肱骨远端骨折AO分型:C1型24例,C2型32例,C3型9例;手术选用肱三头肌-肘肌瓣入路;采用平行加压钢板内固定,强调最大限度地固定远端骨折块、并在骨折髁上水平进行加压的治疗原则。结果 65例均得到随访,随访时间9～18个月,平均12个月;骨折愈合时间8～20周,平均16周;康复使用CPM机进行有计划的肘关节锻炼;按照MEPS肘关节功能评分标准:优20例,良37例,可6例,差2例,总优良率87.6%。并发异位骨化(HO)2例,创伤性关节炎2例,尺神经牵拉伤2例,伤口轻度感染延期愈合3例。结论 平行加压钢板内固定治疗肱骨远端C型骨折,提供了良好的力学稳定结构,使骨折内固定坚固、可靠,允许肘关节早期功能康复练习,肘关节功能恢复较为满意。
Abstract
Objective To analyze the clinical effect of internal fixation for treatment of type-C distal humerus fracture with parallel compression plate. Methods Clinical data of 65 patients with type-C distal humerus fracture were analyzed retrospectively from June 2007 to August 2014. According to the AO classification, there were 24 cases of type C1, 32 cases of type C2, and 9 cases of type C3. Operation of triceps-anconeus flap approach was selected. Internal fixation with parallel compression plate,furthest fixation of the distal fracture fragments and compressive at supracondylar level were the treatment principle. Results All patients were followed up. The follow-up time was 9-18 months, averaged 12months; healing time was 8-20 weeks, average 16 weeks. CPM was used for elbow joint rehabilitation training designedly. We got the excellent result in 20 cases, good in 37, fair in 6 and poor in 2 according to Mayo Elbow Performance Scores (MEPS), the excellent and good rate was 87.6%. Heterotopic ossification was found in 2 cases, traumatic arthritis in 2 cases, ulnar nerve stretch injury in 2 cases, slight wound infection and delayed healing in 3 cases. Conclusions Internal fixation for treatment of type-C distal humerus fracture with parallel compression plate provides excellent mechanical stable structure, dependable fastness, reliable early functional exercise, and satisfactory functional recovery in elbow joint.
关键词
平行加压钢板 /
内固定治疗 /
肱骨远端C型骨折
Key words
parallel compression plate /
internal fixation for treatment /
type-C distal humerus fracture
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 张世良,李海丰,黄秩刚.骨折分类与功能评定[M].3版.北京:人民军医出版社,2008: 316-318.
[2] 赵军舰,程小宾,翟晓刚,等.老年性肱骨近端骨折锁定钢板内固定治疗疗效探讨[J].武警医学,2014,25(12): 1232-1235.
[3] 周 方,郭 琰.成人肱骨髁间髁上骨折患者术后肘关节功能恢复的影响因素[J].中华创伤骨科杂志,2006,8(1): 13-15.
[4] Mejia Silva D, Morales de los Santos R, Cienega Ramos M A, et al. Functional results of two different surgical appruaches in patients with distal humans fractures type C (AO) [J]. Acta Ortop Mex, 2008, 22(l): 26-30.
[5] 尹 刚,郭兴锋,夏俊杰,等. 3种外科入路手术治疗肱骨远端C型骨折的疗效评价[J]. 中国骨与关节损伤杂志,2014,29(5): 454-456.
[6] 王万垠,杨建强,湛梅圣,等.肱三头肌肌腱止点横断入路治疗肱骨远端双柱骨折的初步研究[J].中国骨与关节损伤杂志,2011,26(1): 68-69.
[7] 高 伟, 吴小锋, 黄建华, 等.几种常用肱骨远端关节内粉碎性骨折的内固定方法比较[J]. 中国骨与关节损伤杂志,2007,22(8): 566-567.
[8] Shin S J, Sohn H S,Do N H.A clinical comparison of two different double plating methods for intraarticular distal humerus fractures[J].J Shoulder Elbow Surg,2010,19(1):2-9.
[9] Frankle M A ,Herscovici D Jr,Dipasquale T G,et al. A comparison of open reduction and internal fixation and primary total elbow arthropiasty in the treatment of intraarticular distal humerus fractures in women older than age 65 [J]. J Orthop Trauma, 2003, 17: 473-480.
[10] Athwal G S, Hoxie S C, Rispoli D M, et al. Precontoured parallel plate fixation of AO／OTA type C distal humerus fractures [J].J Orthop Trauma,2009, 23: 575-580.
[11] 蔡 浩,倪晓晖,董蕚良,等.双钢板治疗肱骨髁间骨折3种内固定方式载荷应变与移位[J].中国组织工程研究与临床康复,2011,15(5):4931-4935.
[12] Sanchez-Sotelo J, Torchia M E, O’Driscoll S W. Complex distal humeral fractures: internal fixation with a principle-based parallel-plate technique[J]. J Bone Joint Surg (Am), 2007, 89: 961-969.
[13] 王友华, 孙法瑞, 徐大伟, 等. 平行双接骨板内固定治疗老年肱骨远端粉碎骨折[J]. 中华创伤骨科杂志, 2010, 12(6): 513-517.
[14] Saudan M, Saudan P, perneger T, et al. Celecoxib versus ibuprofen in the prevention of heterotopic ossification following total hip replacement: a prospective randomised trial [J]. J Bone Joint Surg (Br), 2007, 89: 155-159.
PDF(3709 KB)
