双柱理论在骨质疏松性C型肱骨远端骨折治疗中的应用

Double column theory in the treatment of type C osteoporotic distal humeral fractures

目的探讨应用尺骨鹰嘴截骨入路双柱固定方法治疗骨质疏松性肱骨远端骨折的临床疗效。方法对31例肱骨远端C型骨折患者（C1型11例，C2型14例，C3型6例）进行治疗，采用肘后侧正中切口与尺骨鹰嘴截骨入路，应用重建钢板固定以稳定肱骨远端的内、外侧柱，与三角形底边的肱骨远端相固定，形成稳定的三角形框架结构。除1例同时伴有鹰嘴部位骨折骨缺损与肘关节脱位，固定与植骨术后石膏固定3周，其余患者术后2d在CPM帮助下进行被动关节功能操练，4周后逐渐进行抗阻力功能操练。结果29例患者获得6—38个月（平均12．5个月）随访，骨折愈合时间2．5—5．3个月，平均3．5个月。患者肘关节经功能操练后平均活动范围：屈曲130°±16°，伸25°±4°，前臂旋前70°±6°，旋后65°±10°。按照Mayo Clinic肘关节功能评分标准：优10例，良12例，可5例，差2例，优良率为75．9％。结论利用尺骨鹰嘴截骨入路与重建双柱稳定的方法对肱骨远端的骨质疏松性C型骨折进行坚强固定，术后可早期进行功能操练，有利于肘关节功能的恢复，疗效满意。

Objective To discuss the validity of double column theory （DCT） in fixation for osteoporotic distal humeral fractures by analyzing the postoperative functions of the elbow. Methods Thirty-one cases of Type C distal humeral fractures treated in our department were studied retrospectively. We used two reconstruction plates to stabilize lateral and medial columns of the distal humeral and the distal humeral hemline to form a stable triangular frame. Early rehabilitation was performed postoperatively in all cases, except in one who had plastic bandage fixation for 3 weeks because of the type C fracture of the distal humerus combined with olecranon fracture and dislocation of the elbow. Results Twenty-nine cases were followed up for 6 to 38 months （mean, 12. 5 months）. The bone healing time averaged 3.5 months （2. 5 to 5.3 months）. And the mean elbow territory is flexion in 130°± 16°, extension in 25°± 4°, pronation in 70°± 6°, and supination in 65° ± 10° respectively. We got the excellent result in 10 cases, good in 12, fair in 5 and poor in 2 according to Mayo Clinic Elbow Performance Scores. Conclusion The trans-olecranon approach and double-column fixation can rigidly stabilize the osteoporotic type C fracture of the distal humerus so that early rehabilitation and restoration of the elbow function can be facilitated.