成年人肱骨远端C型骨折术后肘关节功能恢复影响因素分析

Analysis of the factors influencing postoperative function of elbow in adults with C-type fracture of distal hmerus

目的探讨成年人肱骨远端C型骨折术后肘关节功能受限的原因。方法对2005年3月至2009年6月收治的23例成年人肱骨远端C型骨折患者，均行切开复位内固定术，采用Mayo肘关节功能评估指数对其疗效进行评定，并选取可能影响术后疗效的因素，如年龄、骨折类型、内固定方式及术后患肢开始功能锻炼时间进行Logistic回归分析。结果23例患者均获随访8～36（18．3±2．1）个月，评分结果：优6例，良8例，可4例，差5例，优良率60．9％（14／23）。≤40岁患者与〉40岁患者的优良率分别为61．5％（8／13）和60．0％（6／10）（P〉0．05）；骨折类型C1、C2、C3型患者的优良率分别为77．8％（7／9）、62．5％（5／8）、50．0％（3/6）（P〈0．05）；钢板内固定患者与克氏针内固定患者的优良率分别为75．0％（9／12）和54．5％（6／11）（P〈0．05）；术后患肢开始功能锻炼时间≤3周患者与〉3周患者的优良率分别为71．4％（10／14）和55．6％（5／9）（P〈0．05）。结论骨折类型、内固定方式及术后患肢开始功能锻炼时间是影响成年人肱骨远端c型骨折术后疗效的主要因素，根据骨折类型使用坚强内固定，术后早期合理功能锻炼可提高术后疗效。

Objective To explore the factors influencing postoperative function of elbow in adults with C-type fracture of distal humerus. Methods From March 2005 to June 2009, 23 patients with C-type fracture of distal humerus were treated with open reduction and internal fixation. The function of the elbow was evaluated with Mayo elbow performance index. Related factors such as age, fracture classification, internal fixation method and initial time of postoperative rehabilitation were analyzed with Logistic regression model. Results The followed up time was 8 -36 （18.3±2.1） months, the results demonstrated 6 excellent, 8 good, 4 fair and 5 poor, the excellent and good rate was 60,9%（ 14/23 ）. The excellent and good rate in the age ≤40 years old and 〉 40 years old were 61.5% （8/13） and 60.0% （6/10）（P 〉 0.05 ）;in C1, C2, C3 type fractures were 77.8% （7/9）, 62.5% （5/8）, 50.0% （3/6） respectively （P 〈 0.05）;in plate patients and in Kirschner patients were 75.0% （9/12） and 54.5% （6/11）（P 〈 0.05）;in postoperative functional exercise ≤ 3 weeks and 〉 3 weeks were 71.4%（10/14） and 55.6% （5/9）（P 〈 0.05 ）. Conclusions The fracture classification, internal fixation method and the initial time of postoperative rehabitation affect the functional restoration of distal fracture of humerus, and proper stable fixation with early suitable exercises according to the fracture classification will help improve the functional restoration.