后路双钢板固定治疗累及远端的肱骨中下段骨折

Clinical observation of treatment of humeral and distal humeral fracture with internal fixation of doubles buttress-plates by posterior approach

目的:探讨后路双钢板固定治疗累及肱骨远端的肱骨中下段骨折的临床疗效。方法:2003年7月至2010年11月,8例累及远端的肱骨中下段骨折患者行经后路切开复位双钢板内固定手术治疗,男7例,女1例;年龄20～51岁,平均32岁;左侧2例、右侧6例,均为肱骨中下段骨折,其中肱骨中下段骨折累及远端5例,肱骨中下段骨折合并远端骨折3例。肱骨远端骨折根据AO分型:A2型4例,A3型1例,B1型1例,B2型1例,C1型1例。8例患者均为闭合性骨折,不伴有桡神经损伤。受伤至手术时间为7～12 d,平均8 d。结果:随访8～18个月,平均15个月。骨折均获愈合,愈合时间12～28周,平均16周。无医源性桡神经损伤及内固定失败病例发生。肘关节活动度为120～140°,平均135°。根据Cassebaum肘关节评分标准评定疗效:优5例;良2例;可1例,优良率87.5%。结论:后路双钢板技术是治疗累及肱骨远端的肱骨中下段骨折的有效方法,固定可靠,愈合率高,并发症少。

Objective： To explore the clinical efficacy of posterior approach treatment with internal fixation of doubles buttress- plates. Methods ：From July 2003 to November 2010, eight patients with humeral and distal humeral fracture were treated by posterior approach internal fixation with doubles buttress -plates. There were seven males and one female, with the average age of 32 years （range,20 - 51 years） ,two cases were left side fracture. According to AO classification, there were four cases of type A2, one case of type A3 ,one case of type B1, one case of type B2, and one ease of type C1. All cases were close fractures, without radial nerve inju- ry. The time before operation was 7 to 12 days,with the mean of eight days. Results： All the patients were followed up from 8 to 18 months,with the mean of 15 months. All fractures were completely healed. The healing time ranged from 18 to 28 weeks,with the mean of 16 weeks. No iatrogenic radial nerve injury or failure of internal fixation occurred. The range of motion of the elbow joint was 120° to 140° , with the mean of 135°. According to the Cassebaum scale, the rating of good to excellent scores was 87.5%. Conclusion：The posterior approach of internal fixation with double buttress - plates is an effective treatment of humeral and distal humeral fractures, with reliable fixation, high healing rate, and few complications.