肱骨髁间粉碎性骨折手术治疗的中远期疗效观察

Observation of mid-term and long-term therapeutic outcome in intercondylar comminuted fracture of humerus

目的总结肱骨髁间粉碎性骨折应用尺骨鹰嘴关节截骨加双钢板固定治疗的中远期疗效。方法采用经尺骨鹰嘴关节截骨、双钢板固定的方法治疗肱骨髁间粉碎性骨折24例,术后2-7天开始主、被动功能康复训练,定期检查指导康复训练结果及X线片的表现作为判断骨折的愈合。同时以Cassebaum方法对肘关节功能进行评价。结果22例获得随访,术后随访24-96个月,平均75.1个月。所有患者截骨处全部愈合,平均愈合6周,有2例可见明显关节活动受限。3例尺神经损伤均行尺神经前移术,3例均恢复神经功能。肘关节功能评价:优12例(55%),良8例(35%),可1例(5%),差l例(5%)。关节平均活动范围为115°。结论经尺骨鹰嘴关节截骨加双钢板固定治疗肱骨髁间粉碎性骨折,方法可靠,可以达到解剖复位,为肘关节早期功能锻炼创造了条件,创伤性关节炎发生率低,中远期疗效优良。

Objective To observe mid - term and long - term therapeutic outcome in intercondylar comminuted fracture of humerus. Methods 24 patients of intercondylar comminuted fracture of humerus were treated surgically through approach of extra- articulr osteotomy of olecranon. The active and passive rehabilitation exercises were start at 2 - 7d post- operation. The outcome of healing in osteotomy was evaluated with physical examination and X- ray and the function of elbow was assessed according to Cassbaum scale. Results 22 patients were followed up from 24 to 96 months （average, 75.1 months） and all these patients healed in 6 weeks averagely. Only 2 cases were found limited locomotion of elbow. The function of the elbow showed excellent in 12 （55 % ）, good in 8 （35 % ）, fair in 1 （5 % ） and poor in 1 （ 5 % ）. The average locomotion of the elbow was 115 degree. Conclusion The treatment outcome indicate that good mid- term and long- term effect by this method in intercondylar comminuted fracture of humerus. It facilitates rehabilitation exercises and provides good results with low complication rate.