摘要
[目的]探讨闭合复位经皮内固定治疗肱骨髁间骨折操作技术的方法及其疗效。[方法]自2001年3月~2004年9月有选择性地对23例Rise-BoroughⅡ、Ⅲ型肱骨髁间骨折中的6例(A组)采用闭合复位空心螺钉和克氏针经皮内固定的技术,其余17例(B组)采用开放复位内固定。随访1~2年,对2组病例手术时间、术中出血量、骨折的愈合时间、术后肘关节功能进行比较。[结果]随访A组6例肱骨髁间骨折患者手术时间1~1.5 h,术中出血量10~20 ml,骨折于9~15周内愈合(平均13.2周),未出现感染、骨折不愈合、骨化性肌炎、尺神经炎。B组17例肱骨髁间骨折患者手术时间1.5~2.5 h,术中使用止血带,出血量200~400 ml,骨折于14~29周愈合,未出现感染、骨折不愈合,出现1例骨化性肌炎。肘关节功能按Aitken-Rorabeck标准进行评定,A组6例患者5例达到优级,1例良。B组7例优级,7例良,2例可,1例差。[结论]采用闭合复位空心钉和克氏针经皮内固定技术治疗部分Rise-BoroughⅡ、Ⅲ型的肱骨髁间骨折较传统开放复位内固定的方法有如下优势:(1)对于骨折局部采用闭合复位,不切开软组织,不剥离骨膜,减少了对骨折局部的血运破坏,降低了术后感染和骨折不愈合的发生率;(2)不需使用止血带,术中出血量很少;(3)相对于切开复位,不需行尺骨鹰嘴截骨或肱三头肌舌型瓣切开,无需尺神经前移,减少了对肘部的医源性损伤,避免了尺骨鹰嘴骨折不愈合、肘关节周围黏连和骨化性肌炎的发生;(4)坚强固定并满足术后早期功能锻炼,术后并发症少,骨折愈合迅速,关节功能优良。通过闭合复位空心钉结合克氏针固定治疗部分肱骨髁间骨折可以取得满意的临床效果。
[ Objective]To explore the methods and effects of closed reduction and percutaneous internal fixation to treat in- tercondylar fractures of humerus. [ Method] From 2001,3 to 2004,9 we selectively treated 6 cases ( group A ) of Rise-Borough Ⅱ ,Ⅲtype of humeral intercondylar fractures with closed reduction and percutaneous internal fixation with hollow screw and Kir- schner's wire. Others (group B) treated with opened reduction and internal fixation with plates and screws. [ Result] Following up 6 - 12 months, the outcome were evaluated with Aitken and Rorabeek rating system. Group A :5 patients were graded as excellent, 1 as good. Group B:7 patients were graded as excellent,7 as good,1 as fair,1 as poor. [ Conclusion]To treat Rise-Borough Ⅱ ,Ⅲ type of humeral intercondylar fractures with closed reduction and percutaneous internal fixation with hollow screw and Kirschner's wire,can decrease iatrogenic impairment, receive reliable fixation and early functional exercise. The fracture union quickly, and the patient has excellent joint function and less postoperative complication.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2007年第14期1048-1051,共4页
Orthopedic Journal of China
关键词
肱骨髁间骨折
闭合复位
经皮固定
intercondylar fracture of humerus
closed reduction
percutaneous fixation