改良尺骨鹰嘴截骨治疗复杂肱骨远端骨折的疗效观察

Clinical observation with modified olecranon osteotomy approach for treatment of complex distal humerus fractures

目的 探讨和总结改良尺骨鹰嘴截骨法治疗复杂肱骨远端骨折的疗效和经验。方法 回顾性分析2013年1月~2016年3月在本科行手术治疗的25例复杂肱骨远端骨折病例,其中AO分型C2型7例,C3型18例,均采用改良尺骨鹰嘴截骨法和解剖型锁定钢板90°双平面固定肱骨远端内外侧柱,截骨块利用锁定钢板固定,术后跟踪随访,利用Mayo肘关节功能评分标准对患者术后关节疼痛、运动功能、稳定性以及日常生活4个方面进行评分,以总分≥90分为优,75~89分为良,60~74分为中,<60分为差,评定疗效并总结经验。结果 25例患者获得10~18个月(平均12.5个月)的随访,骨折全部愈合,无骨折不愈合、内固定松动断裂、感染等并发症,Mayo评分优8例,良13例,中4例。结论 采用改良尺骨鹰嘴截骨和双钢板固定治疗复杂肱骨远端骨折,操作简单、暴露充分、固定可靠、疗效满意。

Objective To investigate and summarize the effect and experience of modified olecranon osteotomy in the treatment of complex distal humerus fractures.Methods A retrospective analysis was performed on 25 cases of complex distal humerus fractures treated in our department from January 2013 to March 2016.There were 7 cases of AO type C2 and18 cases of C3.Modified olecranon osteotomy and anatomic locking plate 90°biplane fixation were used to fix the distal medial and lateral column of humerus.The osteotomy block was fixed with locking plate,and postoperative follow-up was conducted.The Mayo elbow function scoring standard was used to score the postoperative joint pain,motor function,stability and daily life of the patients.The total score≥90 was classified as excellent,75-89 as good,60-74 as medium,and<60 as poor.The efficacy was assessed and the experience was summarized.Results All the 25 patients were followed up for 10-18 months(12.5 months on average),and all the fractures healed without complications such as fracture nonunion,loose fracture of internal fixation,infection,etc.8 patients had excellent Mayo score,13 patients had good Mayo score,and 4 patients had moderate Mayo score.Conclusion Using modified olecranon osteotomy and double plate fixation for the treatment of complex distal humerus fractures,the operation is simple,the exposure is sufficient,the fixation is reliable and the curative effect is satisfactory.