内外侧双钢板固定治疗老年肱骨髁间骨折

Operative treatment of humeral intercondylar fractures in older patients by using bilateral plates fixation

目的探讨经尺骨鹰嘴截骨入路和肱三头肌两侧入路应用肱骨内外侧双钢板治疗老年肱骨髁间骨折的方法和临床疗效。方法自2000年1月～2007年10月采用经尺骨鹰嘴截骨入路和肱三头肌两侧入路结合肱骨内、外双钢板治疗老年肱骨髁间骨折23例,男10例,女13例;年65～85岁,平均78岁。按照Riseborough-Radin分型Ⅱ度6例,Ⅲ度12例,Ⅳ度5例。结果术后约6～8周见骨痂生长,4～10个月骨折愈合,平均5个月,无1例出现无畸形愈合、断钉及感染。肘关节未出现骨性关节炎表现,关节功能恢复满意,合并肱骨干骨折患者行肱骨髓内钉固定后12周摄片示骨折愈合。根据改良的Cassebaum评分系统评价肘关节功能,其中优8例,良10例,中5例,优良率80%。结论肱骨内、外髁双钢板固定老年肱骨髁间骨折牢固可靠,能有效的防止骨折不愈合,并可满足患者早期进行关节功能锻炼。合理选择手术入路,结合应用MIPPO技术可减少术后并发症的发生。

objective To explore the surgical management and its results ofintercondylar fracture of humerus of the older patients through approach ofosteotomy of olecranon or Bilateralis of Triceps Brachii Approach with dual medial and lateral plates. Method From January 2000 to October 2007, 23 older patients of intereondylar fracture of humerus were treated surgically, and the fracture was reduced and fixed with medial and lateral steel plates. The patients were 10 males and 13 females with a mean age of 78 years（range 65-85 years）, According to Riseborough and Radin classification, type Ⅱ fracture was found in 6 cases, type Ⅲ in 12, type Ⅳ in 5. Early rehabilitation exercises was taken. Result Twenty-three fractures were all satisfactory reduced, none had incision infection, one injuries of the ulnar nerve. All patients were followed up from 12 months to28 months （average 18.5 months）, of these 23 patients, all the osteotomies healed in 5 month averagely（range 4-10 months）. The function of the elbow（according to Cassbaum scale）showed excellent in 8 cases, good in 10, fair in 5. The good-excellent rate Was 80%. Conclusion The technique of dual medial and lateral plates for the treatment intercondylar fracture of humerus of the older patients provide solid biomechanical stability witch allow early rehabilitation. Chose the appropriate surgical approach and use the MIPPO technique during the operation can prevent delay-union and nonunion, greatly improve the long-term result of the intercondylar fracture of humerus.