应用ACUMED自主定向肘关节骨板系统治疗成人肱骨远端C型骨折

ACUMED self-orientated elbow plate instruments for type C distal humeral fractures in adults

目的探讨ACUMED自主定向肘关节骨板系统治疗成人肱骨远端粉碎性（C型）骨折的疗效。方法选择2009年5月-2010年10月采用切开复位平行双钢板内固定治疗成人肱骨远端粉碎性骨折患者32例，其中男17例，女15例；年龄21～85岁，平均60岁。左侧15例，右侧17例。全部患者均为闭合性骨折，伴尺神经损伤2例。骨折按照AO分型：C1型12例，C2型12例，c3型8例。受伤至手术时间平均为5．6d。手术均采用肘后正中切口，经尺骨鹰嘴“V”形截骨入路显露肱骨远端。术后24h内进行肌肉舒缩功能锻炼。按照Mayo肘关节功能评分（Mayoelbowperformancescore，MEPS）及X线片评估疗效。结果术后平均随访12个月，全部患者经x线片证实均获I期骨性愈合；术后3例c3型骨折发生异位骨化；均未发生感染、内固定物松动等并发症；肘关节屈伸活动范围8°-140°，平均85°；MEPS评分平均90分（60～100分），其中优13例，良15例，可1例，差3例，优良率88％。结论ACUMED平行双钢板固定技术利用拱门结构稳定的原理，坚强内固定治疗成人肱骨远端粉碎性骨折，重建肱骨远端的骨性结构，配合术后早期功能锻炼，可有效恢复肘关节功能，疗效满意。

Objective To investigate effects of ACUMED self-orientated elbow plate system in treatment of comminuted distal humeral fractures （ type C） in adults. Methods Thirty-two adult cases of comminuted distal humeral fractures treated by open reduction and internal fixation with parallel dual plates from May 2009 to October 2010 were enrolled in the study. There were 17 males and 15 females, at average age of 60 years （range, 21-85 years）. All cases were subjected to closed fractures, involving left side in 15 cases and right side in 17. Besides, two cases had associated ulnar nerve injury. According to AO classification, there were 12 cases of type C1, 12 of type C2 and eight of type C3 fractures. The time from injury to operation averaged 5.6 days. Distal humeri were exposed through posterior median incision of elbow and ＂V＂ shape osteotomy of olecroanon. Muscular contractile and relaxant functional exercise was taken within 24 hours postoperatively. Clinical results were assessed based on Mayo elbow performance score （ MEPS ） and X-ray films. Results X-ray fihns showed that all cases obtained primary bone healing in the follow-up （mean 12 months ）. Three cases of type C3 fractures had heterotopic ossification. All cases had no complications like infections or implant loosening postoperatively. Range of motion in elbow flexion and extension averaged 85° （ range, 8°-140°. MEPS was average 90 points （range, 60-100 points） , including excellent outcomes in 13 cases, good in 15, fair in one and poor in three, with excellence rate of 88%. Conclusion ACUMED parallel dual plate fixation technique based on stability theory of arch structure achieves solid fixation of adult comminuted distal humeral fractures, successfully reconstructs bone structure of distal humeri, and effectively restores elbow joint function in response to early rehabilitation exercise.