严重肱骨髁间骨折手术疗效不佳原因分析

Causes of inefficacy of surgical treatment of severe humeral intercondylar fracture

目的 分析严重肱骨髁间骨折手术疗效不佳的原因。方法 对 31例 (32侧患肢 )肱骨髁间骨折患者采用手术治疗 ,C1型 5例 ,C2 型 8例 ,C3 型 18例 (19侧患肢 )。结果 术后平均随访 32个月。用改良的Cassebaum评分方法 ,优 7例 ,良 8例 ,可 6例 ,差 10例 ,优良率 4 7 8%。 4例发生骨不连。结论 骨质疏松和骨折严重程度是肱骨髁间骨折手术疗效差的主要原因 ;早期的功能锻炼很重要 ,但必需有可靠内固定的保证和合理的锻炼方法 ;C3 型骨折没有可靠的内固定方法 ,不能进行早期功能锻炼 ,骨不连的发生率高 ,对该型骨折尚需寻找更有效的治疗方法。

Objective To investigate causes of inefficacy of surgical treatment of severe humeral intercondylar fracture. Methods 31 cases (32 arms)of humeral intercondylar fracture were treated with operation,of which 5 cases were tpye C 1,8 cases C 2 and 18 cases (19 arms) C 3 according to AO classification. Results All cases were followed up for 32 months on average. According to modified Cassebaum score, the result was excellent in 7 cases, good in 8, fair in 6, and poor in 10. The excellent and good rate was 47 8%. Nonunion was found in 4 cases. Conclusion Osteoporosis and severity of the fractures are the main reasons of inefficacy of surgical treatment of sever humeral intercondylar fracture. Early rehabilitation is very important,but it should be based on reliable internal fixation and proper practical training; For C 3 type fracture, early rehabilitation is limited and nounion rate is high since there is no reliable internal fixation. It is necessary to develop a new way to treat this kind of fracture.