Y形钢板加松质骨螺钉固定和尺神经前置治疗肱骨髁间骨折

The curative effects of humeral intercondylar fracture treated with Y shape plate and spongy bone screw internal fixation and anterior transposition of the ulnar nerve

目的:评价Y形钢板加松质骨螺钉固定及常规尺神经前置治疗肱骨髁间骨折的疗效。方法:2003年7月～2006年6月,采用Y形钢板加松质骨螺钉固定及常规尺神经前置的方式手术治疗肱骨髁间骨折31例。随访资料完整27例,男21例,女6例;年龄16～72岁,平均39岁。肱骨髁间骨折按AO/ASIF分型:C1型17例,C2型8例,C3型2例。除3例合并尺骨鹰嘴骨折经后侧骨折端入路,其余均采用Campbell后侧入路。术后早期肘关节CPM功能练习。结果:随访6～27个月,平均11.8个月,按Cassebaum方法评价疗效:优16例,良8例,可3例。优良率88.9%。3例术前尺神经挫伤随访8个月,1例神经功能恢复不全,另2例均完全恢复。肘关节功能良好。结论:肱骨髁间骨折应尽早解剖复位,尺神经前置可有效减少神经麻痹的发生,对于术前有尺神经挫伤者也有利于神经功能恢复。坚强的固定便于早期功能锻炼,有助于肘关节功能恢复。

objective：The retrospective analysis was carried out to evaluate the curative effects of humeral intereondylar fracture treated with Y shape plate and spongy bone screw internal fixation accompanied by anterior transposition of the ulnar nerve.Methods： From July 2003 to June 2006,thirty-one patients diagnosed as humeral intereondylar fracture were treated in our hospital,twenty-seven of which were followed up and evaluated.By AO/ASIF classification,there was type C1 in 17 eases,type C2 in 8 eases,and type C3 in 2 eases.There were 21 male and 6 female patients with an average of 39 years ranging from 16 to 72 years.They were treated with open reduction,Y shape plate and spongy bone screw internal fixation combined with routine anterior transposition of ulnar nerve.The early CPM mobilization was performed in all patients.Results：The mean follow-up of this group was 11.8 months ranging 6 to 27 months.The outcome was evaluated with eassebaum, 16 of which were regarded as excellent, 8 cases as good,3 eases as fair,as a result,the elbow function was excellent to good in 88.9%.The preoperative ulnar nerve injury was diagnosed in 3 eases,and was followed up for 8 months.One ease recovered poorly,two eases recovered well the elbow function was good.Small soope heterotopie ossification which was in the far end of the braehial triceps developed in one eases associated with cerebral injury 5 weeks after operation,the elbow function was good.Conclusion ： Intereondylar fracture of the distal humerus should be treated surgically as early as possible.Routine anterior transposition of the ulnar nerve may be helpful to reduce the incidence of delayed ulnar nerve palsy and recover the preoperative ulnar nerve injury,rigid fixation is helpful to early exercise and recover the elbow function.