肱骨远端骨折切开复位内固定术后并发症现状

Complications of Open Reduction and Internal Fixation for Distal Humerus Fractures

对于肱骨远端骨折治疗切开复位内固定(open reduction and internalfixation,ORIF)是首选治疗方法。且术前应根据肱骨远端骨折类型和粉碎程度做详细的手术计划。肱骨远端内侧髁和后外侧髁相垂直或肱骨远端内外侧髁相平行的两块解剖锁定型钢板内固定是最佳的内固定方法。手术治疗的目的是获得坚强的内固定、允许术后早期肘关节功能锻炼、防止关节僵硬。尽管内固定和手术技术取得很大的发展,但是肱骨远端骨折切开复位内固定术的并发症仍然非常普遍如:内固定失效、尺神经病变、关节僵硬、异位骨化、骨不连,畸形愈合、切口感染以及鹰嘴截骨术后并发症等。肱骨远端骨折的治疗仍然是巨大的挑战,其需要精细的术中操作和手术经验才能获得良好的临床疗效。

Open reduction and internal fixation is the preferred treatment for distal humerus fracture.A detailed surgical plan should be made according to the type and degree of comminuted distal humeral fractures.Internal fixation with two anatomical locking plates perpendicular to the distal medial condyle and the posterior lateral condyle or parallel to the distal medial lateral condyle of the humerus are the best methods of internal fixation.The purpose of surgery is to obtain a stable internal fixation,to allow early functional exercise of elbow joint and to prevent joint stiffness.Despite the advancement in internal fixation and surgical techniques,complications of open reduction and internal fixation for distal humeral fractures are still common,such as mechanical failure,ulnar neuropathy,stiffness,heterotopic ossification,nonunion,malunion,infection,and complications from olecranon osteotomy.The treatment of distal humeral fractures is still a great challenge,which requires delicate intraoperative operation and surgical experience to achieve good clinical results.