经尺骨鹰嘴关节外截骨应用解剖钛钢板治疗肱骨远端骨折

Approach of extra-articular osteotomy of olecranon for surgical management of distal humeral fracture with anatomical titanium plate

目的经尺骨鹰嘴关节外截骨应用解剖钛钢板治疗肱骨远端骨折,探讨经尺骨鹰嘴关节外斜行截骨入路,应用解剖型钛钢板治疗肱骨髁上及髁间粉碎性骨折的临床疗效。方法22例肱骨远端粉碎性骨折,均采用经尺骨鹰嘴关节外斜行截骨入路,骨折复位后配合拉力钉骨块固定,解剖型钛钢板固定,截骨块采用"U"形钛丝固定。结果肱骨远端骨折按照AO/ASIF分型标准,A39例,C15例,C27例,C31例。术后平均随访时间23个月,骨折全部愈合,平均愈合时间3.9个月。所有截骨块全部愈合,平均愈合时间7.3周,其中1例截骨块畸形愈合,肘关节功能基本正常。按Aitken和Rorabeek肘关节功能评定标准,优16例,良4例,可2例,优良率90.9%。结论经尺骨鹰嘴关节外斜行截骨入路,应用解剖型钛钢板治疗肱骨髁上及髁间粉碎性骨折,手术方法简单、可靠、并发症少、骨折固定牢靠,能早期进行肘关节功能锻炼,获得了良好的疗效。

[Objective] To discuss the clinical efficacy of anatomical titanium plate through approach of extraarticular oblique osteotomy of olecranon in patients with supracondylar and intercondylar distal humeral fracture. [Methods] 22 cases with distal comminuted humeral fracture were treated with internal fixation using titanium plate through a transolecranon osteotomy approach. After reposition fragments were fixed by pulling nails, and block osteotomy were fixed by U titanium wire. [Result] According to AO/ASIF classifation, type A3 fracture was found in 9, C1 in 5, C2 in 7 and C3 in 1.22 cases were followed up for 23 months on average, and all fracture healed in 3.9 months averagely. Of these 22 cases, all the osteotomies healed in 7.3 weeks averagely, no nonunion, delayed union, separation was found. 1 patient with abnormal bone healing was found, but the function of his elbow was normal. The elbow joint function according to Aitken and Rorabeek＇s elbow function rating system was evaluated, and the results showed excel.lent in 16, good in 4, fair in 2 and the excellence rate was 90.9%. [Conclusion] Internal fixation with anatomical titanium plate through approach of extra-articular oblique osteotomy of olecranon in patients with supracondylar and intercondylar distal humeral fracture has many advantages, it provides satisfactory stability with simple technical procedure and solid fixation, and it facilitates rehabilitation exercises and provides good results with low complication rate.