双柱固定治疗肱骨远端复杂骨折

Treatment of complicated fracture in the distal humeral end with double-column fixation

目的探讨依据双柱理论以双钢板治疗肱骨远端复杂骨折的方法及效果。方法 37例肱骨远端复杂骨折患者中男23例,女14例;年龄24～64岁,平均42.7岁。按AO/ASIF分型,A3型11例,C1型6例,C2型8例,C3型4例,髁上骨折骨不连8例。取后正中入路,对A3型患者采用纵向劈开肱三头肌显露并复位骨折,对C1型患者自肱三头肌肌腱两侧进入,显露并复位骨折,对C2、C3型患者作尺骨鹰嘴V型截骨或三头肌舌形肌瓣翻转,直视下复位骨折。使用双重建钢板或解剖钢板分别固定肱骨远端内外侧柱。术后不需外固定,第3天行功能锻炼,定期随访。结果所有患者骨折均愈合,平均愈合时间为17周。依据Cassebaum评分标准,肘关节功能评价优17例,良15例,一般3例,差2例,优良率为86.5%。未发生异位骨化,伸肘肌力未见减退。结论采用双柱固定治疗肱骨远端复杂骨折是必要的,能满足确切固定、早期功能锻炼、良好预后的要求。双重建钢板与解剖钢板两者均可起到良好的治疗效果。双重建钢板具有容易塑形、固定确切和较解剖钢板更为经济的优点。

Objective To investigate the method and effect of double-column fixation in treatment of complicated fracture in the distal humeral end. Methods Thirty-seven patients of complicated fracture in the distal humeral end were treated with double column fixation. There were 23 males and 14 females, aged from 24 to 64 years （42. 7 years on average）. According to the classification of Association for the Study of Internal Fixation （AO/ASIF）, 11 cases were belong to type A3, 6 to type C1, 8 to type C2, 4 to type C3 and 8 cases were nomunion of old fracture. Post-middle approaches were used. The cases of type A3 were treated with the triceps-longitudinal splitting method, the cases of type C1 with triceps-preserving method and the cases of type C2 and C3 with olecranon osteotomy or tonguer-of-triceps method to get articular facet good exposure. The medial and lateral column were fixed respectively with double reconstructive plates or anatomic plates after fracture reduction. No outside fixation was used and functional training were performed since the 3rd day. Results All incision recovered well and all fracture healed completely （average of 17 weeks）. The Cassebaum rating system was adapted to quantitate the final functional motion of the elbow, the results were excellent in 17 cases, good in 15 cases, fair in 3 cases and poor in 2 cases, the excellent and good rate was 86. 5%. No heterotopic ossification happened and the strength of the muscles around the elbow joint recovered to the normal one. Conclusions Double column fixation is necessary to treat the complicated fracture in the distal humeral end, which can get the firm fixation, early function training and good result. There are no difference between double reconstructive plates and anatomic plates. The double reconstructive plate is easier to mould and cheaper than anatomic plates.