AO重建钢板内固定治疗肱骨髁间粉碎性骨折

Open reduction and internal fixation for intercondylar comminuted fractures of the humerus by AO reconstructive plate

目的探讨采用AO重建钢板内固定治疗肱骨髁间粉碎性骨折的方法及疗效。方法1997年3月～2000年9月,手术治疗肱骨髁间粉碎性骨折31例,男24例,女7例;年龄18～67岁,平均37.4岁;左侧17例,右侧14例。按照AO/ASIF分型:C1型11例,C2型12例,C3型8例。其中开放性骨折9例,CusstiloandAdersonⅠ度5例,Ⅱ度4例。合并尺神经损伤5例。所有病例均在伤后48h内行后路经尺骨鹰嘴截骨入路,骨折复位,AO重建钢板内固定或加1/3管型钢板固定。术后24～48h行肘关节被动活动,1周后行肘关节主动功能锻炼。于术后1、3、6个月及1年复查X线片,了解骨折愈合情况。结果31例患者均获得随访,随访时间1～3.4年,平均1年6个月。骨折全部愈合,肘关节功能恢复满意。根据Cassebaum方法评定肘关节术后疗效:优11例,良14例,可6例,优良率80.6%。术后出现伤口感染1例,异位骨化1例,桡神经牵拉损伤2例,经伤口换药,抗感染和神经营养药治疗后恢复。结论采用鹰嘴截骨入路,AO重建钢板内固定治疗肱骨髁间粉碎性骨折,手术中显露充分,骨折达到解剖复位,固定牢靠,术后可以早期行功能锻炼,肘关节功能恢复满意。

Objective To study the method and outcome for intercondylar comminuted fractures of the humerus through open reduction and internal fixation with AO reconstructive plate. Methods From March 1997 to September 2000, 31 cases of intercondylar comminuted fracture of humerus were reviewed, which involved 24 males and 7 females with an average age of 37.4 years (range, 18-67 years). The fracture was located on left side in 17 and on right side in 14. According to AO/ASIF classification, there were C1 in 11, C2 in 12, and C3 in 8, among them, 9 cases were open fractures including of Cusstilo and Aderson typeⅠin 5 and Ⅱ in 4. Posterior trans-olecranon osteotomy with open reduction and internal fixation by AO reconstructive plate or plus 1/3 tube plate were performed in all the cases within 48 hours after injury. The osteotomy was 'V' shape at 2 cm to proximal end of ulna. All the patients began the passive motion exercise within 24-48 h, and active training at one week postoperatively. X-ray was taken in 1, 3, 6 and 12 months after operation to observe the bony union. 5 cases with ulnar nerve injury underwent nerve exploration and anterior transposition. Results All the cases were followed up 1-3.4 years (average, 1.5 years), the fractures healed well, and the elbow function recovered satisfactorily. According to the Cassebaum scoring system, 11 were assessed as excellent 11, good 14 and fair 6, and the excellent-good rate was 80.6%. The complications included 1 infection, 1 heterotopic ossification and 2 injuries of the radial nerve, which recovered with dressings, antibiotics and neural nutrients. Conclusion The technique of AO reconstruction plating for the intercondylar comminuted fractures of the humerus through trans-olecranon approach offers many advantages, such as sufficient exposure, anatomical reduction, stable fixation, earlier exercise and satisfactory elbow function.