梯形截骨双钢板治疗肱骨中下段骨不连

Trapezoid Osteotomy with Double Plates for Middle-distal Humeral Nonumion

目的探讨梯形截骨加双钢板治疗肱骨中下段骨不连的临床效果。方法选取13例肱骨中下段骨不连患者,采用梯形截骨双钢板治疗,术后定期随访,观察骨折愈合时间、骨折愈合率、肢体短缩长度、肘关节功能,根据肘关节功能Mayo评分标准评分。结果本组所有病例手术切口I/甲愈合,无尺神经损伤症状,骨折愈合率100%;平均愈合时间8.0月;上臂平均短缩2.7 cm;1例术后出现桡神经牵拉损伤,脱水消肿、口服营养神经药物后症状消失;1例术后桡神经瘢痕粘连、骨痂压迫,二期行桡神经松解术,神经功能恢复;肘关节功能优8例,良3例,中1例,差1例,1例屈肘0~90°,1例出现肘关节僵硬,行二期松解术后肘关节屈曲达80°;肘关节功能优良率85%。结论梯形截骨双钢板治疗肱骨中下段骨不连具有良好的临床效果,梯形截骨极大增加骨折接触面积,肱骨远端锁定钢板保证断端垂直及侧方稳定,内侧辅助钢板增加旋转稳定,满足骨折愈合所需条件,是一种可靠的手术方法。

ABSTRACT Objective To discuss the clinical effect of trapezoid osteotomy with double plates on middle-distal hu- meral nonumion. Methods 13 cases with middle-distal humeral nonumion received trapezoid osteotomy with double paltes ; regular follow-up after operation was made to observe the healing time of bone fracture, the healing rate of bone fracture and the length of limb shortening, the elbow function was evaluated with Mayo Elbow Score. Results The in- cisions in all the cases reached Grade A, no ulnar nerve injury was found and the healing rate of bone fracture was 100% with the average healing time of 8.0 months and the average length of limb shortening of 2.7 cm ; distraction in- jury of radial nerve occurred in 1 case after operation and symptoms disappeared after dehydration and oral administra- tion of neurotrophic drugs ; scar adhesion and callus repression occurred in 1 case after operation and the nerve function recovered after radial nerve relaxation ; excellent elbow joint function was found in 8 cases, good in 3 cases, medium in 1 case and poor in 1 case; the good rate of elbow joint function reached 85%. Conclusions Trapezoid osteotomy with double plates is of good clinical curative effect on middle-distal humeral nonumion, trapezoid osteotomy greatly enlarges the contact area of broken bones while the fixing plates at distal humerus keeps the broken end vertical and the lateral side stable.