双侧钢板内固定治疗肱骨远端C型骨折的疗效分析

Effectiveness analysis of double-plate internal fixation in treatment of distal humerus fractures of C mode

目的回顾性分析双侧钢板内固定治疗肱骨远端C型骨折的疗效。方法56例肱骨远端C型骨折患者,男30例,女26例;年龄18-70岁,平均为(50±32)岁。左侧25例,右侧31例。开放性骨折13例,其中GustiloⅠ型6例,GustiloⅡ型7例;闭合性骨折43例。按照内固定研究学会(AO／ASIF)分型标准:C1型11例, C2型23例,C3型22例。合并其他部位骨折8例,合并尺神经损伤9例。所有患者均采用尺骨鹰嘴截骨入路,骨折复位后双钢板固定,其中采用重建钢板固定21例,解剖型钢板固定35例。受伤至手术时间为0-14 d,中位时间为8 d。按Morrey功能评分标准对肘关节功能进行评分。结果全部病例均获得随访,随访时间为6-70个月,中位时间为30个月;骨折愈合时间为2-4个月,平均为(2．8±1．3)个月。10例患者术后出现尺神经损伤症状,2例出现轻度肘内翻畸形,4例出现尺骨鹰嘴截骨处延迟愈合,2例出现异位骨化。肘关节功能:优36例,良11例,差9例。结论肱骨远端C型骨折双钢板固定坚固,能早期进行功能锻炼,有利于关节功能的恢复。

Objective To analyze the effectiveness of double-plate internal fixation in treatment of distal humerus fractures of C mode. Method Fifty-six patients with distal humerus fracture of C mode were treated by double-plate internal fixation. The patients included 30 males and 26 females, with 25 affected the left, 31 the right; the mean age was 50 ± 32 years（18-70 years）. Thirteen cases had open fracture, including 6 Gustilo Ⅰ and 7 Gustilo Ⅱ. Forty-three had closed fracture, including 11 C1 , 23 C2, and 22 C3 according to the criteria of AO system. Eight cases had multiple fractures and 9 had ulnar nerve damage. All cases were operated though olecranon ulnar process osteotomy; after reduction of fracture, double-plate internal fixation was performed, including 21 cases used reconstruction plates, and 35 anatomical plates. The average duration between fracture and operation was 8 days（0-14 d）. Results All cases were followed up for 6-70 months, with an average of 30 months. The mean duration of bone union was 2-4 months, with an average of 2.8 ± 1.3 months. Ten cases had symptoms of ulnar nerve dysfunction after operation, 2 had cubitus varus, and 4 had delayed union of ulnar olecranon process. Ectopic ossification occurred in 2 cases. The recovered elbow function were classified according to Morrey System assessment： 36 eases were excellent, 11 good,9 poor. Conclusion The approach through olecranon ulnar process osteotomy is effective and easy to perform. Double-plate internal fixation is stable enough to allow early exercises in favor of articular function recovery. （Shanghai Med J, 2007, 30：333-335）