老年肱骨远端骨折内固定术疗效评价

Therapeutic evaluation of internal fixation on distal humeral fracture in senile patients

目的探讨切开复位内固定术在老年肱骨远端骨折治疗中的意义。方法回顾性分析2006年1月-2015年12月收治的老年肱骨远端骨折患者78例,平均年龄72.4岁。手术均采用后入路路径,54例C型骨折采用尺骨鹰嘴截骨入路,24例A型骨折行经肱三头肌入路。术后根据肘关节正侧位X线片随访,评估骨折愈合情况、固定材料状态(移位、断裂)及骨关节炎程度;肘关节活动范围使用手动测角仪;肘关节功能评估采用梅奥肘关节功能评分(MEPS)及臂、肩、手残疾调查问卷表(DASH)。结果术后随访至2016年6月,72例顺利完成术后X线及功能检查,6例失访,平均随访时间42个月。屈肘118.86°(70°～140°),伸肘25°(0°～40°);DASH平均得分为19.87(0～63.63);MEPS平均得分为86。优良率达90.3%。75%患者骨关节炎分级为0～1级。结论对于老年肱骨远端骨折患者,选择合理的内固定技术和内固定物,术后效果理想。

Objective To evaluate the radiological and functional results of open reduction and internal fixation of distal humeral fractures. Methods tLetrospectively analyzed 78 patients with distal humeral fractures treated by open reduction and internal fixation between January 2006 to December 2015 in the orthopaedics department of Dongtai people hospital. The surgery was carried out in all the cases using a posterior approach. Olecranon osteotomy was performed in 54 of the patients （all with a Type C fracture pattern） and with transtriceps approach in 24 cases （Type A）. For the radiographic assessment, X-rays of elbow projections （anteroposterior and lateral） were assessed to analyze the fracture pattern, state of the internal fixation material （migration, breakage）, and the degree of osteoarthritis. Elbow motion range was measured with a manual goniometer, and the elbow function was assessed by using the scales of the Mayo Elbow Performance Score （MEPS） and the Disabilities of the Arm, Shoulder and Hand （DASH）. Results By the end of follow-up in June 2016, 72 patients had receive an X-ray and functional assessment, and 2 patients lost follow-up. Mean follow-up time was 42 months （from 15 months to 5 years）. Mean joint motion range was 118.86° in flexion （70°-140°） and 25° in extension （0°-40°）. The mean DASH score was 19.87 （0-63.63）; Mean MEPS scale outcome was 86 and the excellent good rate was 90.3%. 79.1% of the patients presented Grade 0 or 1 according to the Knirk and Jupiter scale. Conclusion For distal humeral fracture in the senile patient, the result is satisfactory with the reasonable internal fixation technique and internal fixation.