经肱三头肌侧方入路垂直双钢板内固定治疗肱骨远端骨折

Perpendicular double plating through triceps brachial in treating distal humeral fracture

目的探讨经肱三头肌侧方入路垂直双钢板内固定治疗肱骨远端骨折的临床疗效。方法采用经肱三头肌两侧入路垂直双钢板内固定治疗32例肱骨远端骨折患者,根据AO分型,A3型13例,C1型12例,C2型5例,C3型2例。结果 32例均获随访,时间9~24（14±1.2）个月。骨折均愈合。患者术后患肘活动度：16例伸15°~屈130°,12例伸30°~屈120°,4例伸40°~屈90°。根据Cassebaum评分标准进行临床疗效评定：优16例,良12例,可4例,优良率87.5%。2例C3型骨折因暴露困难、关节面欠平整而出现术后较严重的创伤性关节炎。无感染、骨折不愈合和骨化性肌炎发生。结论经肱三头肌侧方入路垂直双钢板技术具有创伤小、固定可靠、可早期功能锻炼等优点,适用于治疗除C3型以外所有的肱骨远端骨折。

Objective To explore the clinical efficacy of treating distal humeral fractures with transtriceps brachial sides and dual plating internal fixation. Methods 32 patients of complicated fracture in the distal humera1 end were treated with transtriceps brachial sides and dual plating internal fixation. According to the classification of Association for the Study of Internal Fixation（ AO / ASIF）,13 cases were belonged to type A3,12 to type C1,5 to type C2,2 to type C3. Results The 32 cases were followed up for 9 ~ 24（14 ± 1. 2） months. All of the cases were healed. In 16 cases,the motion arc of elbow in extension and flexion was 15° ~ 130°;In 12 cases,the motion arc was 30° ~ 120°;In 4 cases,the motion arc was 40° ~ 90°. According to the Cassebaum score system,16 were assessed as excellent,12 as good and 4 as fair,the excellent-good rate was 87. 5%. Traumatic arthritis occurred in two cases of the type C3 due to exposing difficulty and uneven articular surface. No infection,nonunion and myositis ossificans had been reported. Conclusions Treatment of complicated fractures in the distal humeral end with transtriceps brachial sides and dual plating internal fixation can lead to minimal operation lesion and firm fixation,and allow early functional exercise after operation.