肱骨髁间骨折手术治疗效果分析

Intercondylar Fractures of the Humerus:Surgical Result Analysis

目的探讨手术治疗肱骨髁间骨折的方法及疗效。方法 2004年1月～2009年12月手术治疗肱骨髁间骨折40例,34例采用尺骨鹰嘴截骨入路,6例采用肱三头肌舌形瓣入路,克氏针加螺钉固定10例,Y形钛板固定30例。对本组资料的手术入路、内固定方式及术后并发症进行分析。结果所有患者均获随访,平均时间12个月,肘关节功能根据Aitken评定标准进行评定,Y形钛板固定的30例中优20例,良9例,可1例;克氏针加螺钉固定的10例中良5例,可1例,差4例。Y形钛板固定的30例中发生术中尺神经损伤1例,异位骨化性肌炎2例;克氏针加螺钉固定的10例中发生术中尺神经损伤3例,骨折延迟愈合4例,异位骨化性肌炎4例。结论采用尺骨鹰嘴截骨入路、Y形钛板内固定治疗肱骨髁间骨折,显露充分,固定可靠,肘关节功能恢复满意,并发症少,是一种行之有效的手术治疗方法。

Objective To evaluate the surgical management and its results of intercondylar fractures of the humerus through internal fixation. Methods During January 2004 and November 2009, 40 patients with intercondylar fractures of the humerus were surgically treated. 34 patients took the approach of osteotomy of olecranon, and 6 took the approach of liguliform flap of musculus triceps brachii. The fractures were reduced and fixed with screws and needles in 10 cases, and ＂ Y＂ Ti-plate in 30 cases. Clinical data of the surgical approach, types of internal fixation and the complica- tions were analyzed. Results All the patients were followed up for an average period of 12 months. According to the Airken scoring system, 20 were assessed as excellent, 9 as good, 1 as fair in ＂ Y＂ titanium plate group, and 5 were assessed as good, 1 as fair, and 4 as poor in screws and needles group. Of the 30 patients with ＂ Y＂ titanium plate, the complications included 1 injury of the ulnar nerve,and 2 heterotopic ossifications. Of the 10 patients with serews and needles, the complications included 3 injuries of the ulnar nerve, 4 bony union delays, and 4 heterotopic ossifications. Conclnsion The technique of ＂ Y＂ Ti-plate for the intercondylar fractures of the humerus through trans-olecranon approach offers an effeetive internal fixation with sufficient exposure, stable fixation, satisfactory elbow function with a lower rate of complications.