成人肱骨髁间粉碎性骨折伴尺神经损伤手术治疗

Surgical treatment for adult comminuted humeral intercondylar fractures which companied with ulnar nerve injury

目的:探讨成人肱骨髁间粉碎性骨折伴尺神经损伤手术方法。方法:对13例肱骨髁间粉碎性骨折伴尺神经损伤患者均行肱二头肌内、外侧双切口,沿肌肉间隙进行骨折端暴露。Ⅰ期行尺神经前置术,内、外侧均以AO重建钢板固定,术后早期进行功能锻炼。所有病例均于术后1个月、3个月、6个月及1年摄X光片复查。结果:13例病人平均随访13个月(3～36个月)。骨折全部愈合,肘关节功能恢复满意,用Cassebaum方法评价:优8例,良3例,可2例,优良率84.6%,尺神经卡压症状均于术后消失或减轻。结论:(1)肱二头肌内外侧双切口可很好地显露肱骨髁部骨折端,对正常组织结构及肱骨髁部血运影响小。(2)内外侧双AO重建钢板固定牢靠,便于术后早期功能锻炼。(3)Ⅰ期行尺神经松解前置术对尺神经损伤治疗有效。

Objective： To evaluate the operational method and curative effect of the comminuted humeral intercondylar fractures which companied with ulnar nerve injury. Methods. Among 13 patients with comminuted humeral intercondylar fractures which companied with ulnar nerve injury there were 3 C1 cases, 6 C2 cases, and 4 C3 cases according to AO/ASIF classification. They were exposed by exterior and interior incision. There were 11 male cases and 2 female cases ,the average age was 27 years old. The ulnar nerves were placed anteriorly during the primary operation, the interior and exterior humeral intercondylars were fixed by AO reconstructive plates. The patients exercised early after operation. Every case was rechecked by X ray after one month,three months and six months. Results. Every case was followed up, the average time was 13 months （3 months to 36 months ）. All of the fractures were healed, and the function of elbow joints were recovered satisfuctorily, there were 8 excellent cases, 3 fine cases and 2 fair cases , the success rate was 84.6%. The compressive symptoms of ulnar nerve were disappeared or relieved. Conclusions. Firstly, the end of intercondylar fracture can be fully exposed by interior and exterior incisions, which has less damage for the normal tissue and blood supply of humeral intercondylar. Secondly, the fractures can be fixed stablely by two side AO reconstituted plates, that can help patients exercise early. Thirdly, the patients can get good effect by decompression and anterial transplantion of ulnar nerve in primary operation.