微创附加钢板治疗下肢长骨骨折髓内钉固定术后肥大性骨不连

Effect of functional exercise at different time and different immobilization positions on functional recovery of elbow joint with type C distal humeral fractures

目的总结微创附加钢板治疗下肢长骨骨折髓内钉固定术后肥大性骨不连的可行性和效果。方法回顾分析2010年1月—2015年8月采用微创附加钢板治疗的11例下肢长骨骨折髓内钉固定术后肥大性骨不连患者临床资料。男8例,女3例;年龄18~63岁,平均34.6岁。股骨8例,胫骨3例。原始骨折国际内固定研究协会(AO/ASIF)分型:A型5例,B型4例,C型2例。髓内钉固定手术至本次手术时间为6~22个月,平均12.4个月。术前患者膝关节或踝关节活动度(range of motion,ROM)较对侧减少(30.71±14.72)°。结果手术切口均Ⅰ期愈合。11例患者均获随访,随访时间12~30个月,平均14个月。X线片示骨折均愈合,愈合时间4~8个月,平均5.7个月。无感染、神经血管损伤、钢板髓内钉断裂等并发症发生。末次随访时,患膝关节或踝关节ROM较对侧减少(15.36±12.17)°,与术前比较差异有统计学意义(t=5.571,P=0.000)。患肢功能恢复按SchatzkerLambert股骨远端骨折功能评分或Kaikkonen踝关节损伤功能评分分级法,优5例,良5例,可1例,优良率90.9%。结论微创附加钢板治疗下肢长骨骨折髓内钉固定术后肥大性骨不连,方法简便,安全可行,效果良好。

Objective To investigate the effect of functional exercises at different time and different immobilization positions on the functional recovery of elbow joint with type C distal humeral fractures. Methods A total of 120 patients with type C distal humeral fractures admitted to the hospital between June 2013 and July 2015 were included in the study. They were randomly allocated to 3 groups, 40 patients in each group. Group A： functional exercises began immediately after the operation; Group B： the affected elbow was fixed at 90° flexion for 1 week and then began functional exercises after 1 week of immobilization; Group C： the affected elbow was fixed at 30° extension for 1 week and then began functional exercises after 1 week of immobilization. There was no significant difference in gender, age, fracture pattern, fracture side, injury time, and surgical approach between groups （P〉0.05）. Results In groups A and B, 1 case had incision redness and swelling respectively, and the other incisions healed by first intention. Five patients occurred myositis ossificans in group A, 4 cases in group B, and 5 cases in group C. The incidence of complications in groups A, B,and C was 15.0% （6/40）, 12.5% （5/40）, and 12.5% （5/40）, respectively. There was no significant difference between groups （X2=0.144, P=0.930）. All patients were followed up 6-25 months, with an average of 9.8 months. At 2 weeks after operation, the Mayo elbow joint function score of group A was significantly higher than those of groups B and C （P〈0.05）, and the visual analogue scale （VAS） of group A was significantly lower than those of groups B and C （P〈0.05）. There was no significant difference between groups B and C （P〉0.05）. At 6 months after operation, there was no significant difference in Mayo elbow joint function score and VAS score between groups （P〉0.05）. At 2 weeks and 6 months after operation, the flexion and extension activities of elbow joint in groups A and C were better than that in group B （P〈0.05）, and there was no significant difference between groups A and C （P〉0.05）. There was no significant difference in forearm rotation between groups （P〉0.05）. All fractures of 3 groups achieved clinical healing, and there was no significant difference in healing time between groups （P〉0.05）. Conclusion Early functional exercises can relieve pain and obtain better elbow flexion and extesion activities after operation. The elbow joint fixed at 30° extension is better than at 90° flexion in elbow flexion and extension activitis.