经尺骨鹰嘴“V”型截骨双侧锁定钢板内固定治疗复杂性肱骨远端骨折的临床研究

Clinical research of olecranon "V" shaped osteotomy with double locking plate internal fixation in the treatment of complexity distal humerus fracture

目的 探讨经尺骨鹰嘴“V”型截骨入路治疗复杂性肱骨远端骨折的临床效果.方法 回顾性分析本院骨科2009 年6 月至2012 年6 月18 例复杂性肱骨远端骨折经尺骨鹰嘴“V”型截骨切开复位钢板内固定术患者的临床资料.其中,男10 例,女8 例;年龄23 ～ 65 岁,平均38.7 岁.AO/ASIF 分型C1 型4 例,C2 型8 例,C3 型6 例.对手术入路、内固定方式、手术疗效等进行评价.结果 18 例患者均完成6 ～ 24 个月的随访,平均15.2 个月;骨折均愈合,愈合时间为3.6 ～ 9.8 个月,平均5.1个月;无切口感染、内固定松动及断裂等,未出现鹰嘴截骨的相关并发症;Mayo 肘关节功能评分（MEPS）为63 ～ 98 分,平均（87.4±5.3）分,优9 例,良7 例,可1 例,差1 例;肘关节屈曲80°～ 145°,平均（129.2±13.8）°,伸直5°～ 40°,平均（18.4±8.2）°;改良Cassebaum 评分系统：优10 例,良6 例,中1 例,差1 例,优良率为88.9%.结论 经尺骨鹰嘴“V”型截骨入路双侧锁定钢板内固定治疗复杂性肱骨远端骨折,具有显露充分、直视下良好整复关节面、内固定坚强可靠等优点,治疗效果满意.

Objective To investigate the clinical efficacy of olecranon 'V' shaped osteotomy with double locking plate internal fixation in the treatment of complexity distal humerus fracture. Method 18 patients with complexity distal humerus fracture who adopted olecranon 'V' shaped osteotomy with double locking plate internal fixation in our hospital from June 2009 to June 2012 were retrospectively analyzed, 10 males and 8 females, with the mean age of 38.7(23 ~ 65) years. According to the AO/ASIF classification, there were 4 cases of type C1, 8 cases of type C2 and 6 cases of type C3. The operative approach internal fixation and surgical effct were evaluated. Result 18 patients were followed up for 6 to 24 months(average 15.2 months). All fractures healed. The healing time was 3.6 ~ 9.8 months(average 5.1 months). There were no incision, infection and failure of osteosynthesis. Complications with olecranon osteotomy did not occur. The MEPS score was 63 ~ 98 points(average 87.4±5.3). 9 cases were graded as excellent; 7 cases as good; 1 case as fair; 1 case as poor. The range of motion of flextion was 80° ~ 145°(average 129.2°±13.8°), extension was 5° ~ 40°(average 18.4°±8.2°). According to the criteria of Cassebaum, the results were excellent in 10 cases, 6 cases as good, 1 case as fair, 1 case as poor, and the excellent and good rate was 88.9%. Conclusion Olecranon 'V' shaped osteotomy with double locking plate internal fixation in the treatment of complexity distal humerus fracture, is featured with the advantages of full exposion and good vision of the entire articular surface under direct sight, strong and reliable fixation. The clinical result is satisfactory.