尺骨鹰嘴截骨入路内固定治疗成人肱骨远端陈旧骨折

Internal fixation via olecranon osteotomy approach for treatment of the old fractures of the distal humerus

目的探讨尺骨鹰嘴截骨入路内固定治疗成人肱骨远端陈旧骨折的疗效。方法采用尺骨鹰嘴截骨入路内固定治疗14例成人肱骨远端陈旧骨折患者。记录骨折复位情况、骨折愈合情况、肘关节活动度,采用改良An-Morrey肘关节评分标准评价疗效。结果患者均获得随访,时间10~18(11.8±1.6)个月。术后4周X线片显示骨折对位对线良好,内固定牢靠,有骨痂形成。骨折均愈合,时间12~24周。末次随访时,采用改良An-Morrey肘关节评分标准评价疗效:优10例,良3例,可1例,优良率13/14;肘关节屈曲80°~140°(109.6°±12.2°),前臂内旋75°~80°(77.3°±2.1°)、外旋78°~82°(79.8°±2.7°)。结论尺骨鹰嘴截骨入路内固定治疗成人肱骨远端陈旧骨折,术野暴露充分,清创、复位、内固定操作方便,且内固定牢靠,患者可早期功能锻炼,肘关节功能恢复良好。

Objective To investigate the clinical effect of olecranon osteotomy approach for treatment of the old fractures of the distal humerus.Methods The 14 adult patients with old distal humeral fractures were treated by internal fixation via olecranon osteotomy.The fracture reduction,fracture healing and elbow joint range of motion were recorded,the improved An-Morrey elbow joint scoring criterion was used to evaluate the effect.Results All patients were followed up for 10~18(11.8±1.6)months.X-ray films at 4 weeks after operation showed that the fracture alignment were good,the internal fixation was reliable,and there was callus formation.All fractures healed in 12~24 weeks.At the last follow-up,the improved An-Morrey elbow score criterion was used to evaluate the efficacy:excellent in 10 cases,good in 3,fair in 1 case,and the excellent and good rate was 13/14;Elbow flexion range was 80°~140°(109.6°±12.2°),forearm pronation was 75°~80°(77.3°±2.1°),forearm external rotation was 78°~82°(79.8°±2.7°).Conclusions The olecranon osteotomy approach for treatment of the adult old fracture of distal humerus is sufficient exposure,convenient debridement,reduction,internal fixation operation is easy,and internal fixation is reliable,the patients can do early functional exercise,with good recovery of elbow function.