平行与垂直双钢板内固定治疗AO-C型肱骨远端骨折的疗效比较

Parallel versus perpendicular anatomic double plating for AO type C distal humerus fractures

目的比较平行双钢板及垂直双钢板内固定治疗AO-C型肱骨远端骨折的临床疗效。方法回顾性分析自2011-03—2016-01诊治的32例AO-C型肱骨远端骨折,采用平行双钢板内固定治疗17例(平行组),采用垂直双钢板内固定治疗15例(垂直组)。比较2组术后6个月VAS评分,末次随时肘关节活动屈伸范围、前臂旋转范围及肘关节功能Mayo评分,术后并发症发生情况。结果 32例均获得随访6~12个月,平均10.5个月。平行组1例出现尺神经损伤,予以甲钴胺片营养神经治疗4个月后神经症状恢复;垂直组1例出现轻度异位骨化,患肘屈伸约92°,旋转102°,活动明显受限;平行组、垂直组各2例出现肘关节活动明显受限,需二期行肘关节松解术。2组并发症比较差异无统计学意义(P>0.05)。平行组术后6个月VAS评分为(0.59±0.71)分,垂直组为(0.60±0.63)分,2组差异无统计学意义(P>0.05)。2组患侧肘关节屈伸活动度、前臂旋转活动度及肘关节功能Mayo评分比较差异均无统计学意义(P>0.05)。结论垂直双钢板或平行双钢板内固定治疗AO-C型肱骨远端骨折均可取得良好疗效,应根据骨折的形态、软组织损伤程度、患者一般情况选择适当的内固定方式。

Objective To analyze the clinical efficacy of parallel double plate and perpendicular double plate in treating the AO type C distal humerus fractures. Methods Retrospective analysis was conducted for parallel double plate and vertical double plate fixation in the treatment of 32 patients with the AO type C distal humerus fractures from March 2012 to January 2016 in our hospital. Seventeen cases were treated with parallel double plate internal fixation （parallel group） while 15 cases were treated with vertical double plate internal fixation （vertical group）. VAS score of 6 months after surgery, the range of flexion and extension of the elbow, forearm rotation and elbow joint function Mayo score, postoperative complications at the last follow-up were recorded and analyzed statistically. Results All of the 32 patients were followed up for an average time of 10.5 months（range, 6-12 months）. One patient in parallel group had ulnar nerve injury and recovered well after treated with oral Mecobalamin tablets for 4 months. One patient in vertical group appeared mild heterotopic ossification and that caused elbow ROM significantly limited with flexion and extension of about 92 degrees, rotation of 102 degrees. Two cases in each group had limited/activity of elbow joint and received arthrolysis of elbow joint. There was no significant difference in postoperative complications between the two groups（P 〉0.05）. There was no significant difference in the average VAS scores of half a year between the two groups （P 〉0.05）, the average VAS score was （0.59±0.71） in parallel group and （0.60±0.63） in vertical group. There was also no significant difference between the 2 groups in the flexion and extension of the elbow, forearm rotation and elbow joint function Mayo score （P 〉0.05）. Conclusion Both fixation methods are effective in treatment of comminuted distal humeral fractures in adults. Appropriate internal fixation methods should be selected according to the type of the fracture, soft tissue injury, age, family economic status.