切开复位内固定治疗GustiloⅠ-Ⅱ型肱骨远端开放骨折
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摘要
目的 :探讨切开复位内固定治疗GustiloⅠ-Ⅱ型肱骨远端骨折的临床疗效。方法:自2013年5月至2017年6月采用切开复位内固定治疗24例GustiloⅠ-Ⅱ型肱骨远端开放骨折患者,其中男20例,女4例;年龄14～65(41.3±13.1)岁;根据Gustilo分型,Ⅰ型16例,Ⅱ型8例。记录患肘的活动范围、术后并发症及二次手术的情况,并于术后12个月时采用主观疼痛视觉模拟评分(visual analogue scale,VAS),Mayo肘关节功能评分(Mayo elbow performance score,MEPS)及快速肩臂手功能障碍评分量表(quick disabilities of the arm,shoulder and hand,QuickDASH)评价患肘功能恢复情况。结果:所有患者获得随访,时间15～60(34.1±11.9)个月。术后12个月VAS评分为0(0,2)分。术后患肘屈伸活动度为50°～145°(115.2±26.1)°,旋转100°～160°(147.7±17.0)°。MEPS评分为90.0±9.1,优14例,良10例。QuickDASH评分为4.6(0,14.8)分。并发症发生22例,包括尺神经症状、内固定激惹等,二次手术患者10例。结论:切开复位内固定是一种治疗GustiloⅠ-Ⅱ型肱骨远端开放骨折安全有效的方法,患者活动范围好,功能评分满意。
Objective:To analysis clinical effects of open reduction and internal fixation in treating Gustilo type ⅠandⅡpatients with open distal humeral fracture. Methods:From 2013 May to 2017 June,24 patient with Gustilo gradeⅠandⅡopen distal humeral fractures were treated with open reduction and internal fixation,including 20 males and 4 females,aged from 14 to 65 years old with an average of(41.3±13.1) years old. According to Gustilo classification,16 patients were typeⅠ,8 patients were typeⅡ. Range of motion,complications and secondary surgery were recorded;elbow function were evaluated with VAS(visual analogue scale),MEPS(Mayo elbow performance score) and QuickDASH(quick disabilities of the arm,shoulder,and hand) at 12 months after operation. Results:All patients were followed up from 15 to 60 years with an average of(34.1 ±11.9) months. VAS score was 0(0,2);flexion and extension ranged from 50 ° to 145° with an average of(115.2 ±26.1)°;the range of rotation ranged from 100° to 160° with an average of(147.7±17.0)°. MEPS score was for 75 to 90(90.0±9.1),and 14 patients got excellent result,10 patients moderate. Quick DASH score was 4.6(0,14.8). There were 22 patients occurred complications,such as ulnar nerve symptom and internal fixation irritation,and 10 patients accepted the second operation. Conclusion:Open reduction and internal fixation is a safe and efficient method in treating Gustilo type ⅠandⅡpatients with open distal humeral fractures,which has an advantages of good range of movement and function score.
Objective:To analysis clinical effects of open reduction and internal fixation in treating Gustilo type ⅠandⅡpatients with open distal humeral fracture. Methods:From 2013 May to 2017 June,24 patient with Gustilo gradeⅠandⅡopen distal humeral fractures were treated with open reduction and internal fixation,including 20 males and 4 females,aged from 14 to 65 years old with an average of(41.3±13.1) years old. According to Gustilo classification,16 patients were typeⅠ,8 patients were typeⅡ. Range of motion,complications and secondary surgery were recorded;elbow function were evaluated with VAS(visual analogue scale),MEPS(Mayo elbow performance score) and QuickDASH(quick disabilities of the arm,shoulder,and hand) at 12 months after operation. Results:All patients were followed up from 15 to 60 years with an average of(34.1 ±11.9) months. VAS score was 0(0,2);flexion and extension ranged from 50 ° to 145° with an average of(115.2 ±26.1)°;the range of rotation ranged from 100° to 160° with an average of(147.7±17.0)°. MEPS score was for 75 to 90(90.0±9.1),and 14 patients got excellent result,10 patients moderate. Quick DASH score was 4.6(0,14.8). There were 22 patients occurred complications,such as ulnar nerve symptom and internal fixation irritation,and 10 patients accepted the second operation. Conclusion:Open reduction and internal fixation is a safe and efficient method in treating Gustilo type ⅠandⅡpatients with open distal humeral fractures,which has an advantages of good range of movement and function score.
引文
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[3]Gustilo RB,Anderson JT.Prevention of infection in the treatment of one thousand and twenty five open fractures of long bones:retrospective and prospective analyses[J].J Bone Joint Surg Am,1976,58(4):453-458.
[4]Crichton N.Visual analogue scale(VAS)[J].J Clin Nurs,2001,10(5):706.
[5]Cusick MC,Bonnaig NS,Azar FM,et al.Accuracy and reliability of the Mayo elbow performance score[J].J Hand Surg,2014,39(6):1146-1150.
[6]Beaton DE,Wright JG,Katz JN.Development of the QuickDASH:comparison of three item reduction approaches[J].J Bone Joint Surg Am,2005,87(5):1038-1046.
[7]Min W,Anwar A,Ding BC,et al.Open distal humerus fractures--review of the literature[J].Bull NYU Hosp Jt Dis,2010,68(4):257-261.
[8]Chaudhary S,Patil N,Bagaria V,et al.Open intercondylar fractures of the distal humerus:Management using a mini external fixator construct[J].J Shoulder Elbow Surg,2008,17(3):465-470.
[9]K觟mürcüM,Yanmis I,Atesalp AS,et al.Treatment results for open comminuted distal humerus intra articuler fractures with Ilizarov circular external fixator[J].Mil Med,2003,168(9):694-697.
[10]McKee MD,Kim J,Kebaish K,et al.Functional outcome after open supracondylar fractures of the humerus.The effect of the surgical approach[J].J Bone Joint Surg Br,2000,82(5):646-651.
[11]Gustilo RB,Mendoza RM,Williams DN.Problems in the management of typeⅢ(severe)open fractures:a new classification of typeⅢopen fractures[J].J Trauma,1984,24(8):742-746.
[12]Kundel K,Braun W,Wieberneit J,et al.Intraarticular distal humerus fractures.Factors affecting functional outcome[J].Clin Orthop Relat Res,1996,(332):200-208.
[13]朱前拯,段亚景,杨雨润,等.解剖锁定接骨板治疗C型肱骨远端骨折的疗效分析[J].中华肩肘外科电子杂志,2015,3(2):22-27.ZHU QZ,DUAN YJ,YANG YR,et al.Analysis of the outcomes of anatomical lock plate for C type distal humerus fracture[J].Zhonghua Jian Zhou Wai Ke Dian Zi Za Zhi,2015,3(2):22-27.Chinese.
[14]查晔军,蒋协远,公茂琪.老年肱骨远端骨折的治疗选择[J].中国骨伤,2012,25(9):773-778.ZHA YJ,JIANG XY,GONG MQ.Choices to treat fracture of distal humerus in the elderly patients[J].Zhongguo Gu Shang/China JOrthop Trauma,2012,25(9):773-778.Chinese with abstract in English.
[15]Mostafavi HR,Tornetta P.Open fractures of the humerus treated with external fixation[J].Clin Orthop Relat Res,1997,(337):187-197.
[2]Kellam JF,Meinberg EG,Agel J,et al.Introduction:Fracture and dislocation classification compendium-2018:international comprehensive classification of fractures and dislocations committee[J].JOrthop Trauma,2018,32(Suppl 1):S1-S10.
[3]Gustilo RB,Anderson JT.Prevention of infection in the treatment of one thousand and twenty five open fractures of long bones:retrospective and prospective analyses[J].J Bone Joint Surg Am,1976,58(4):453-458.
[4]Crichton N.Visual analogue scale(VAS)[J].J Clin Nurs,2001,10(5):706.
[5]Cusick MC,Bonnaig NS,Azar FM,et al.Accuracy and reliability of the Mayo elbow performance score[J].J Hand Surg,2014,39(6):1146-1150.
[6]Beaton DE,Wright JG,Katz JN.Development of the QuickDASH:comparison of three item reduction approaches[J].J Bone Joint Surg Am,2005,87(5):1038-1046.
[7]Min W,Anwar A,Ding BC,et al.Open distal humerus fractures--review of the literature[J].Bull NYU Hosp Jt Dis,2010,68(4):257-261.
[8]Chaudhary S,Patil N,Bagaria V,et al.Open intercondylar fractures of the distal humerus:Management using a mini external fixator construct[J].J Shoulder Elbow Surg,2008,17(3):465-470.
[9]K觟mürcüM,Yanmis I,Atesalp AS,et al.Treatment results for open comminuted distal humerus intra articuler fractures with Ilizarov circular external fixator[J].Mil Med,2003,168(9):694-697.
[10]McKee MD,Kim J,Kebaish K,et al.Functional outcome after open supracondylar fractures of the humerus.The effect of the surgical approach[J].J Bone Joint Surg Br,2000,82(5):646-651.
[11]Gustilo RB,Mendoza RM,Williams DN.Problems in the management of typeⅢ(severe)open fractures:a new classification of typeⅢopen fractures[J].J Trauma,1984,24(8):742-746.
[12]Kundel K,Braun W,Wieberneit J,et al.Intraarticular distal humerus fractures.Factors affecting functional outcome[J].Clin Orthop Relat Res,1996,(332):200-208.
[13]朱前拯,段亚景,杨雨润,等.解剖锁定接骨板治疗C型肱骨远端骨折的疗效分析[J].中华肩肘外科电子杂志,2015,3(2):22-27.ZHU QZ,DUAN YJ,YANG YR,et al.Analysis of the outcomes of anatomical lock plate for C type distal humerus fracture[J].Zhonghua Jian Zhou Wai Ke Dian Zi Za Zhi,2015,3(2):22-27.Chinese.
[14]查晔军,蒋协远,公茂琪.老年肱骨远端骨折的治疗选择[J].中国骨伤,2012,25(9):773-778.ZHA YJ,JIANG XY,GONG MQ.Choices to treat fracture of distal humerus in the elderly patients[J].Zhongguo Gu Shang/China JOrthop Trauma,2012,25(9):773-778.Chinese with abstract in English.
[15]Mostafavi HR,Tornetta P.Open fractures of the humerus treated with external fixation[J].Clin Orthop Relat Res,1997,(337):187-197.
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