肱骨髁间严重粉碎骨折的内固定治疗

The internal fixation for severe comminuted intercondylar fractures of humerus

目的总结肱骨髁间严重粉碎骨折内固定治疗的效果和相关因素。方法手术治疗肱骨髁间粉碎骨折18例,按AO分型C2型10例、C3型8例。18例中经肱三头肌舌形瓣入路6例;尺骨鹰嘴截骨入路10例;经尺骨鹰嘴骨折进入2例。C2型骨折中髁间螺钉加AO重建钢板、1/3管型板固定10例;髁间螺钉加AO重建钢板固定2例;C3型骨折中髁间螺钉加AO重建钢板、1/3管型板固定5例,髁间螺钉加AO重建钢板、克氏针固定1例、髁间髁上螺钉、克氏针固定2例。结果18例随访8～63个月,平均38个月,采用改良的Cassebaum评分系统评定,优8例,良5例,可3例,差2例。结论积极手术治疗,关节结构解剖重建,骨折稳定固定,术后早期功能锻炼是良好治疗结果的保证。首选尺骨鹰嘴截骨入路。

Objective To discuss relative factors of successful internal fixation for humeral comminuted intercondylar fractures. Methods 18 cases of humeral comminuted intercondylar fracture were treated with operation form March 1998 to March 2002. According to AO Classification, there were 10 cases of type C2, and 8 cases of type C3. The fractures were approached through tongue of triceps in 6 cases, through osteotomy of olecranon in 10 cases, and through fracture of olecranon in 2 cases. In the group of type C2, the fixation with intercondylar screw and 2 plates (AO reconstruction plate and one third tubular plate) was done in 10 cases, and with intercondylar screw and AO reconstruction plate in 2 cases. In the group of type C3, the fixation with intercondylar screw and 2 plates was done in 5 cases, with intercondylar screw and AO reconstruction plate in 1 case, and screw and kirschner wire in 2 cases. Results 18 cases were followed up from 8 months to 63 months, averaging 38 months. They were evaluated with modified Cassebaum rating system. 8 cases were rated as excellent, 5 as good, 3 as fair, and 2 as poor. Conclusions Early operation, anatomical reduction, rigid fixation and early exercise are the key factors of a successful treatment. The first choice of approach is osteotomy of olecranon.