三种内固定方法治疗肱骨髁间粉碎性骨折的疗效比较

Comparison of three internal fixation methods in treatment of type C3 fractures of distal humerus

目的比较二种内固定方法治疗肱骨髁间粉碎性骨折的疗效。方法2002年2月～2005年1月,采用单钢板螺钉(A组,21例)、“Y”形钢板(B组,33例)和双钢板(C组,19例)固定治疗73例肱骨髁间粉碎性骨折患者,根据Müller的AO分型标准均为C3型骨折。所有患者均取肘后正中切口,采用肱三头肌舌形瓣入路。对本组患者的内固定方式、肘关节功能及并发症等资料进行回顾性研究。结果所有患者获得12～36个月(平均22．3个月)随访。术后12个月,肘关节功能按Jupiter评定标准进行评定,A组优良率为57．1%,B组为81．8%,C组为89．5%。B、C组术后肘关节功能恢复明显较A组好,差异有显著性意义(P＜0．05)；根据Sodergard关于肱骨髁间骨折内固定失败的判断标准,A组失败率为33．3%,B组为15．2%,C组为5．3%,C组内固定失败率明显较A、B组低,B组明显较A组低,差异均有显著性意义(P＜0．05)。无一例出现切口皮肤坏死和深部感染。结论单钢板螺钉治疗肱骨髁间粉碎性骨折,术后肘关节功能恢复较差,内固定松动、断裂及肘内翻畸形发生率亦较高,临床应慎用此方法；“Y”形钢板和双钢板治疗肱骨髁间粉碎性骨折,符合肱骨远端生物力学特点,术后肘关节功能恢复良好者；但“Y”形钢板由于其自身的形态、结构特点,术后内固定松动发生率较高,因此对于肱骨内、外髁骨块较小者,不宜选用“Y”形钢板固定。

Objective To evaluate three internal fixation methods in treatment of type C3 fractures of distal humerus. Methods From February 2002 to January 2005, 73 cases of humeral intercondylar fractures were treated with single plating （Group A, 21 cases）, Y-shape plating （Group B, 33 cases） and dual plating （Group C, 19 cases） . According to the AO/ASIF classification, 73 cases belonged to type C3. The posterior midline incision and the approach of liguliform flap of musculus triceps brachii were used for all the cases. The recorded clinical data were reviewed to analyze effects of internal fixation methods, functions of the elbow and the complications. Results All the cases were followed up. The follow-ups ranged from 12 to 36 months, with an average of 22. 3 months. By the end of the twelfth month, according to the Jupiter scoring system, the elbow function was excellent and good in 57. 1% of cases in Group A, 81.8% in Group B and 89.5% in Group C, the difference between Group A and Groups B and C being statistically significant（ P 〈 0. 05）. Meanwhile, according to Sodergard＇s criteria for failure of internal fixation system for intercondylar fracture of humerus, the failure rate was 33.3% in Group A, 15.2% in Group B and 5.3% in Group C. The loosening or breakage rate in Group C was significantly lower than in Groups A and B （ P 〈 0. 05 ）, and that in Group B was obviously lower than in Group A （ P 〈 0. 05） . No incision necrosis or deep infection occurred. Conclusions The type C3 fractures of distal humerus should not be treated with single plating, because the functional outcome of elbow joint is poor, and the rate of loosening or breakage of internal fixation is higher than other fixation methods. Y-shape plating and dual plating are good for them, but Y-shape plating is not good for severe intercondylar comminuted fractures of the humerus, because its peculiar shape tends to lead to a higher rate of loosening.