肱骨远端解剖型锁定接骨板治疗肱骨远端骨折

Application of distal humeral plate in the treatment of distal humerus fracture

目的评价新型肱骨远端解剖型锁定接骨板(DHP)的临床使用方法及治疗效果。方法选择2008年7月～2010年10月使用DHP治疗且获得随访的肱骨远端骨折患者11例,骨折AO分型:A型1例,B型3例,C型7例,均采用切开复位DHP固定,术后不附加外固定,第2天开始功能锻炼。采用Mayo肘关节评分标准(MEPS)及X线片评价临床疗效。结果所有患者均随访12～22个月,平均16个月。11例患者骨折均愈合,平均愈合时间为16周,无内固定失效或骨折再移位。10例均无肘关节疼痛,1例有轻微疼痛,前臂旋转功能同健侧一致,肘关节屈伸活动平均79°(10°～130°),屈曲平均108°(60°～130°),伸直平均25°(0°～80°)。MEPS评分平均91分(60～100分),其中,优9例,良1例,中1例,优良率为90.9%。结论 DHP对于较高位的肱骨髁上部分粉碎骨折、低位的关节面的粉碎骨折,以及合并骨质疏松的肱骨远端骨折均能够达到满意的固定效果,允许早期功能锻炼。

Objective To investigate the surgical technique and effect of distal humeral plate （DHP） in the treatment of distal humerus fracture. Methods From July 2008 to October 2010, 11 cases of patients with distal humerus fracture treated with DHP and complete follow-up were selected. According to AO classification, 1 case was type A, 3 cases were type B, 7 cases were type C. All patients were given open reduction DHP fixation treatment, and no external fixation was attached after surgery. 2 days after surgery, patients began to take functional exercise. Mayo Elbow Performance Score （MEPS） and X ray were used to evaluate the clinical effects. Results All patients were followed up for 12 to 22 months, average of 16 months. Fractures were healed in all cases, the mean healing time was 16 weeks, there was no hardware failure or loss of reduction. 10 cases had elbow pain, but 1 case had slight pain. Forearm rotation function of patients were consistent with the contralateral, the average of flexion and extension of the elbow joint was 79°（10 to 130°）, the average of elbow flexion was 108° （60° to 130°） and the average of elbow extension was 25° （0° to 80°）. The average of Mayo Elbow Performance Score was 91 points （60 to 100 points）. The score was excellent in 9 cases, good in 1 case, the excellent and good rate was 90.9%. Conclusion DHP treatment is satisfied with the stability of fixation for comminuted supracondylar fracture of humerus, comminuted fracture of low articular surface, and distal humeral fractures associated with osteoporosis, which can permit patients to take early function rehabilitation .