双钢板两种不同的内固定方式治疗肱骨髁间骨折比较研究
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摘要
目的对比研究解剖型双钢板垂直内固定方式和平行内固定方式,在治疗肱骨远端关节内骨折中的临床疗效及手术安全性。方法本研究纳入2012年1月-2014年12月于我院创伤外科接受切开复位内固定治疗的肱骨远端C型骨折患者28例,随机1:1对照分为实验组和治疗组,全部患者采用解剖型双钢板内固定治疗。术中实验组患者采用双钢板平行固定方法,对照组患者接受双钢板垂直固定方法,观察比较两组患者手术时间、术中出血、术后1个月肘关节屈伸活动度、前臂旋转活动度和术后6个月Mayo肘关节评分情况。结果全部患者骨折愈合良好,无并发症发生。实验组患者在手术时间和术中出血方面与对照组组间差异无统计学意义(P>0.05);实验组患者术后1月肘关节屈伸活动度为(163.3±9.59)°,对照组为(163.3±7.80)°,术后6个月Mayo肘关节评分实验组为(90.9±5.72),优良率91.7%,对照组为(90.3±6.11),优良率95.8%,两组患者疗效无统计学差异(P>0.05)。结论解剖型双钢板在治疗肱骨远端关节内骨折时,垂直固定与平行固定均可以取得良好的临床疗效,在临床应用中,应根据患者的骨折形态和个体差异,选择适合的固定方式。
Objective To compare the clinical efficacy and surgical safety of anatomical double plate vertical internal fixation and parallel internal fixation in the treatment of distal humeral fractures. Methods This study included 28 cases of distal humeral C fractures treated with open reduction and internal fixation from January 2012 to December 2014 in traumatology department of our hospital, which divided into the experimental group and the treatment group randomly,14 cases for each group, all the patients were treated with anatomical double plate fixation. Patients in the experimental group were treated by double plate parallel fixation, while the control group received double plate vertical fixation during operation, observed and compared the operation time, intraoperative bleeding, elbow flexion and extension, forearm rotation after 1 month operation, and Mayo elbow score at 6 months after operation of the two-group patients. Results All fractures healed well without complications. There was no significant difference in operation time and intraoperative bleeding between the experimental group and the control group(P>0.05);The flexion and extension of elbow joint in experimental group patients 1 month after operation was(163.3±9.59)°, the control group was(163.3±7.80)°, the Mayo elbow score in the experimental group after 6 months operation was(90.9 ± 5.72), the excellent and good rate was 91.7%, and the control group was(90.3 ± 6.11), the excellent and good rate was95.8%,there was nosignificant difference between the curative effect oftwo-group patients(P > 0.05).Conclusion Anatomical double plate with vertical fixation and parallel fixation can achieve good clinical results in the treatment of intra-articular fractures of the distal humerus, the appropriate fixation should be chosen accordingtothe fracture patterns and individual differences ofthe patients in clinical practice.
Objective To compare the clinical efficacy and surgical safety of anatomical double plate vertical internal fixation and parallel internal fixation in the treatment of distal humeral fractures. Methods This study included 28 cases of distal humeral C fractures treated with open reduction and internal fixation from January 2012 to December 2014 in traumatology department of our hospital, which divided into the experimental group and the treatment group randomly,14 cases for each group, all the patients were treated with anatomical double plate fixation. Patients in the experimental group were treated by double plate parallel fixation, while the control group received double plate vertical fixation during operation, observed and compared the operation time, intraoperative bleeding, elbow flexion and extension, forearm rotation after 1 month operation, and Mayo elbow score at 6 months after operation of the two-group patients. Results All fractures healed well without complications. There was no significant difference in operation time and intraoperative bleeding between the experimental group and the control group(P>0.05);The flexion and extension of elbow joint in experimental group patients 1 month after operation was(163.3±9.59)°, the control group was(163.3±7.80)°, the Mayo elbow score in the experimental group after 6 months operation was(90.9 ± 5.72), the excellent and good rate was 91.7%, and the control group was(90.3 ± 6.11), the excellent and good rate was95.8%,there was nosignificant difference between the curative effect oftwo-group patients(P > 0.05).Conclusion Anatomical double plate with vertical fixation and parallel fixation can achieve good clinical results in the treatment of intra-articular fractures of the distal humerus, the appropriate fixation should be chosen accordingtothe fracture patterns and individual differences ofthe patients in clinical practice.
引文
[1]祝先锋,何大鹏,白正发,等.平行双钢板法内固定治疗肱骨远端C型骨折[J].中华手外科杂志,2012,28(4):196-197.
[2]陈明光.AO可塑形双钢板置入内固定修复老年肱骨远端骨折:效果的影响因素分析[J].中国组织工程研究,2015,(31):5016-5020.
[3]姚中凯,陈春华,杨晨松等.解剖型双钢板治疗肱骨远端复杂型骨折的疗效分析[J].中华手外科杂志,2016,32(5):385-386.
[4]赵瑛,鲍晓毅,尹志强等.双钢板固定术治疗肱骨远端骨折74例分析[J].重庆医学,2014,(1):42-43,47.
[5]冯总权,陈建峰,许步伟等.肱骨髁间解剖特点及钢板治疗粉碎性骨折临床分析[J].中华创伤科杂志,2015,25(3):98-100.
[6]谢志新,吴迪,虢新莲,等.Y形钢板和双钢板经不同置入途径治疗肱骨髁间骨折的比较[J].新疆医学.2014,12(10):2805.
[7]杨超,周庆.平行双钢板与Y型钢板治疗肱骨远端C型骨折的临床疗效观察[J].河北医学,2016,22(4):569-572.
[2]陈明光.AO可塑形双钢板置入内固定修复老年肱骨远端骨折:效果的影响因素分析[J].中国组织工程研究,2015,(31):5016-5020.
[3]姚中凯,陈春华,杨晨松等.解剖型双钢板治疗肱骨远端复杂型骨折的疗效分析[J].中华手外科杂志,2016,32(5):385-386.
[4]赵瑛,鲍晓毅,尹志强等.双钢板固定术治疗肱骨远端骨折74例分析[J].重庆医学,2014,(1):42-43,47.
[5]冯总权,陈建峰,许步伟等.肱骨髁间解剖特点及钢板治疗粉碎性骨折临床分析[J].中华创伤科杂志,2015,25(3):98-100.
[6]谢志新,吴迪,虢新莲,等.Y形钢板和双钢板经不同置入途径治疗肱骨髁间骨折的比较[J].新疆医学.2014,12(10):2805.
[7]杨超,周庆.平行双钢板与Y型钢板治疗肱骨远端C型骨折的临床疗效观察[J].河北医学,2016,22(4):569-572.