双接骨板固定治疗肱骨远端骨折

TREATMENT OF DISTAL HUMERUS FRACTURE WITH DOUBLE-PLATING FIXATION

目的探讨双接骨板固定治疗肱骨远端骨折的方法及临床疗效。方法 2003年4月-2009年1月,采用肘后正中切口、肱三头肌内外缘两侧入路,有限接触动力加压接骨板和重建接骨板治疗肱骨远端骨折21例。男12例,女9例;年龄20～63岁,平均39岁。致伤原因:跌伤13例,车祸伤6例,高处坠落伤2例。骨折按照国际内固定研究协会(AO/ASIF)分型:12-B1型8例,12-B2型2例,12-B3型7例,13-A2型3例,13-A3型1例。除3例翻修手术外,其余患者均在受伤11d内手术,平均4.8d。结果 1例术后2周切口出现分泌物,经换药后愈合;其余切口均Ⅰ期愈合。2例术后2d出现一过性环、小指麻木感。21例均获随访,随访时间13～18个月,平均15个月。术后6个月X线片示骨折均愈合。无术后关节粘连发生,肘关节活动范围为0～135°。肘关节功能按Morrey标准评定:优17例,良2例,中2例,优良率90.5%。结论应用双接骨板固定治疗肱骨远端骨折具有内固定坚强可靠,术后可早期功能锻炼的优点,疗效满意。

Objective To investigate the method and clinical effect of double-plating fixation in treatment of distal humerus fractures.Methods From April 2003 to January 2009,21 patients with distal humerus fracture were treated with limited contact compression plate and reconstruction plate via posterior elbow incision and approach inside and outside the edge of both sides of the triceps.There were 12 males and 9 females,aged from 20 to 63 years（39 years on average）.The causes of injury were falling in 13 cases,traffic accident in 6 cases,and falling from height in 2 cases.According to the classification of Association for the Study of Internal Fixation（AO/ASIF）,8 cases were classified as type 12-B1,2 as type 12-B2,7 as type 12-B3,3 as type 13-A2,and 1 as type 13-A3.The course of disease averaged 4.8 days.Results Secretion was observed at incision in 1 case 2 weeks after operation,and incision healed after dressing change;other incisions healed by first intention.Transient numbness of ring and little fingers occurred in 2 cases 2 days after operation;no iatrogenic nerve paralysis occurred.All patients were followed up 13 to 18 months（15 months on average）.The X-ray films showed bone healed 6 months after operation.No postoperative joint adhesion occurred,and the motion of elbow joint ranged from 0° to 135°.According to Morrey evaluation standard,the results were excellent in 17 cases,good in 2 cases,and fair in 2 case;the excellent and good rate was 90.5%.Conclusion Double-plating fixation has the advantages of wide indications,rigid internal fixation,and significant curative effects in treatment of distal humerus fractures.