4种内固定方法治疗肱骨髁部粉碎性骨折的疗效比较

Comparsion of the outcome of humeral condylar comminuted fractures treated with four kinds of internal fixation methods

目的比较4种内固定方法治疗肱骨髁部粉碎性骨折的疗效。方法采用交叉克氏针+石膏外固定、AO双钢板内固定、Y形钢板内固定和有限内固定+绞链式肘关节外固定架固定等4种不同的内固定方法治疗肱骨髁上与髁间粉碎性骨折72例。结果随访时间平均15个月,骨折愈合时间平均3.8个月。无骨不连、骨折畸形愈合、骨化性肌炎、迟发性尺神经炎等发生。按Aitken和Rorabeek标准进行肘关节功能评定,优良率:A组73.3%,B组89.5%,C组92.0%,D组92.3%。结论绞链式肘关节外支架辅助内固定治疗肱骨髁部粉碎骨折能提高肘关节侧方稳定性,可早期功能锻炼。Y形钢板内固定具有固定牢靠、操作简单等优点。

Objective To compare the outcome of humeral condylar comminuted fractures treated with four kinds of internal fixation methods. Methods 72 cases with humeral condylar comminuted fractures were treated with open reduction and internal fixation with cross pins,AO double-plate, Y-shaped plate or internal fixation in combination with hinged external fixator. Results All patients were followed up for mean 15 months , average time of bony union were 3.8 months. According to Aitken and Rorabeek elbow function rating system, the elbow function was excellent and good： in 73.3% of A group , 89.5% of B group, 92.0% of D group, 92.3% of D group. Conclusions The protocol of internal fixation in combination with the hinged external fixator can help maintain lateral stability, facilitate early motion of the injured elbow which is helpful for fracture union, ligament repair and recovery of the joint function. It has advantages such as rigid fixation, easy manipulation in the treatment of humeral condylar comminuted fractures with Y-shaped plate fixation.