应用成骨力值的概念治疗肱骨髁部粉碎性骨折

Using the concept of physiological osteogenic stress for the treatmet of comminuted fracture of condyle of humerus

目的：探索肱骨髁部记忆加压固定器治疗肱骨髁部粉碎性骨折的手术方法及临床效果。方法：采用肱骨髁部记忆加压固定器治疗肱骨髁部粉碎性骨折16例,其中男9例,女7例;年龄18~56岁,平均35.6岁。原始骨折按AO/ASIF肱骨髁部骨折分型：A3型4例,C2型7例,C3型5例。所有患者均采用尺骨鹰嘴截骨入路,骨断端复位后以肱骨髁部记忆加压固定器内固定,辅助使用克氏针、张力带钢丝、加压螺钉。结果：16例患者均获随访,随访时间8~62个月,平均26.5个月。肱骨髁部骨折在术后平均3.8个月获得骨性愈合。术后未出现骨折端移位、内固定断裂、骨不连、畸形愈合及迟发性尺神经炎等并发症。参照Cassebaum肘关节功能评分系统,优6例,良8例,中1例,差1例,优良率87.5%。结论：肱骨髁部记忆加压固定器持骨稳定,可在骨块间提供持续纵向压应力,有效促进骨折愈合,是治疗肱骨髁部粉碎性骨折的一种可行的新方法。

Objective： To explore operative method and therapeutic effects of condylar shape memory compressive connector for the treatment of comminuted fracture of condyle of humerus. Methods： Among sixteen patients with comminuted fracture of condyle of humerus,9 patients were male and 7 patients were female,ranging in age from 18 to 56 years,with an average of 35.6 years. All the patients were treated with shape memory compressive connector. According to AO/ASIF system, the frac- tures were classified. There were 4 type-A3,7 type-C2 and 5 type-C3 fractures. All patients were operated with the approach of olecranon osteotomy. Broken ends were reduced and fixed with shape memory compressive connector. Kirschner wire, compres- sion screw and steel wire were used supplementally. Results： The average duration of follow-up was 26. 5 months （ range, 8 to 62 months）. The time of bone union averaged 3.8 months. Complication such as displacement, breakage of internal fixation, nonunion, malunion and tardy ulnar neuritis did not occur. According to modified Cassebaum scoring system, the result as excellent for 6 cases, good for 8 cases, fair for 1 and poor for 1. The excellent and good rate was 87.5%. Conclusion： Shape-memory compressive connector can fix bone blocks reliable and provide continuous compression axially between the bone blocks which can promote the union of fractures. It is a new technique for comminuted fracture of condyle of humerus.