复杂肱骨髁间骨折几种固定方法的疗效对比分析
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摘要
目的:
比较不同内固定方法治疗复杂的肱骨髁间骨折的临床疗效。探讨克氏针、Y型钢板、双钢板治疗复杂肱骨髁间骨折的适应症、方法、并发症。
资料与方法:
我科自2001年10月至2007年12月共收治肱骨髁间C型骨折39例,年龄15-87岁,按AO/ASIF分型均为C型骨折,其中克氏针固定19例,Y型钢板固定6例,双钢板固定10例,非手术的4例.对于手术组的患者均获随访2-24个月,从骨折的愈合时间,并发症,术后临床疗效评价等方面比较。
结果:
所有病例均获得随访。结果术后疗效采用Aitken和Rorabeek标准进行肘关节功能评定,克氏针固定优良率78.94%,Y型钢板固定优良率83.3%,双钢板固定优良率80%,三者优良率比较(p〉0.05)无显著差异。三者骨折的愈合时间比较无明显差异。仅Y型钢板固定组出现1例慢性感染,经换药及内固定物取出后治愈。
结论:
克氏针、Y型钢板、双钢板固定对于治疗肱骨髁间骨折均有较高的优良率,可以根据情况选用不同的内固定方式,Y型钢板及双钢板的生物力学特性更适合骨折愈合的需要,而克氏针固定具有花费低,操作简单,创伤小等优点,但其固定稳定性不如Y型钢板及双钢板,不能进行早期关节功能练习。
Objective:To evaluate effects of the methods used to treat complicate intercondylar fractures of humeru, and to explore the indication, complication of the methods, which treat the complicate intercondylar fractures of humerus with Kirschner wire, Y shaped plate and double reconstruction plate.
Method:From Oct 2001 to Oct 2007, we has treated 39 patients of complicate humeral intercondylar fractures . Age of the patients was ranged 15 to 87 years. All these cases were classified to type C fracture. Among all patients, 19 cases were treated with Kirschner wire,6 cases were treated with Y shaped plate and 10 cases were treated with double reconstruction plate, other 4 cases were treated with nonoperative way. The patients in operation group were followed up for 2 to 24 months, compare the bone healing , complication and clinic effect of different methods. Results: All the patients were followed up. The outcome were evaluated according to Aitken and Rorabeek rating system. The ratio of excellent and good was 78.9% in cases treated with Kirschner wire , 83.3% in cases treated with Y shaped plate and 80.0% in cases treated with double reconstruction plate. The ratio and bone healing of three groups had no significant deviation (p>0.05). Only 1 chronic infection happened in Y shaped plate group, which finally healed well after dislodge of the plate.
Conclusion: Treat the complicate intercondylar fractures of humerus with Kirschner wire, Y shaped plate and double reconstruction plate had got good clinical effect. The medical biomechanics character of Y shaped plate and double reconstruction plate was much better for bone healing, but the operation with Kirschner wire was much simple, cheap, and the trauma the operation was less. So we should chose the internal fixation according to specific condition.
比较不同内固定方法治疗复杂的肱骨髁间骨折的临床疗效。探讨克氏针、Y型钢板、双钢板治疗复杂肱骨髁间骨折的适应症、方法、并发症。
资料与方法:
我科自2001年10月至2007年12月共收治肱骨髁间C型骨折39例,年龄15-87岁,按AO/ASIF分型均为C型骨折,其中克氏针固定19例,Y型钢板固定6例,双钢板固定10例,非手术的4例.对于手术组的患者均获随访2-24个月,从骨折的愈合时间,并发症,术后临床疗效评价等方面比较。
结果:
所有病例均获得随访。结果术后疗效采用Aitken和Rorabeek标准进行肘关节功能评定,克氏针固定优良率78.94%,Y型钢板固定优良率83.3%,双钢板固定优良率80%,三者优良率比较(p〉0.05)无显著差异。三者骨折的愈合时间比较无明显差异。仅Y型钢板固定组出现1例慢性感染,经换药及内固定物取出后治愈。
结论:
克氏针、Y型钢板、双钢板固定对于治疗肱骨髁间骨折均有较高的优良率,可以根据情况选用不同的内固定方式,Y型钢板及双钢板的生物力学特性更适合骨折愈合的需要,而克氏针固定具有花费低,操作简单,创伤小等优点,但其固定稳定性不如Y型钢板及双钢板,不能进行早期关节功能练习。
Objective:To evaluate effects of the methods used to treat complicate intercondylar fractures of humeru, and to explore the indication, complication of the methods, which treat the complicate intercondylar fractures of humerus with Kirschner wire, Y shaped plate and double reconstruction plate.
Method:From Oct 2001 to Oct 2007, we has treated 39 patients of complicate humeral intercondylar fractures . Age of the patients was ranged 15 to 87 years. All these cases were classified to type C fracture. Among all patients, 19 cases were treated with Kirschner wire,6 cases were treated with Y shaped plate and 10 cases were treated with double reconstruction plate, other 4 cases were treated with nonoperative way. The patients in operation group were followed up for 2 to 24 months, compare the bone healing , complication and clinic effect of different methods. Results: All the patients were followed up. The outcome were evaluated according to Aitken and Rorabeek rating system. The ratio of excellent and good was 78.9% in cases treated with Kirschner wire , 83.3% in cases treated with Y shaped plate and 80.0% in cases treated with double reconstruction plate. The ratio and bone healing of three groups had no significant deviation (p>0.05). Only 1 chronic infection happened in Y shaped plate group, which finally healed well after dislodge of the plate.
Conclusion: Treat the complicate intercondylar fractures of humerus with Kirschner wire, Y shaped plate and double reconstruction plate had got good clinical effect. The medical biomechanics character of Y shaped plate and double reconstruction plate was much better for bone healing, but the operation with Kirschner wire was much simple, cheap, and the trauma the operation was less. So we should chose the internal fixation according to specific condition.
引文
1. Helfet DL, Kloen P,Anand N,Rosen HS.Open reduction and internal fixation of delayed unions and nonunions of fractures of the distal part of the humerus J Bone JointSurgAm.2003 Jan;85-A(1): 33-40.
2. Greiner S ,Hass NP,Bail HJ. Outcome after open reduction and angular stable internal fixation for supra-intercondylar fractures of the distal humerus: preliminary results with the LCP distal humerus system. Arch Northup Trauma Surge. 2007 Aug 23.
3. Papaioannnou N ,Babis GC, Kalavritinos J etal. Operativetreatment of type C intra-articular fractures of the distal humerus:the role of stability achieved at surgery on final outcome. Injury1995 Apr,26(3)169-173.
4.Muller ME,Nazarian S,Koch P,etal:The ComprehensiveClassification of Fractures of LongBones. Berlin,Springer--Verlag, 1990.
5.Mehne DK, Jupiter JB: Fractures of the distal humerus. In Browner B , Jupiter JB , Levine A ,etaI(eds):Skeletal Trauma. Philadelphia, WB Saunders, 1991,1146.
6. 卢世璧 王继芳 王岩 陈继营主译 坎贝尔骨科手术学(第10版)3卷 (2896)
7.Ring D ,Jupiter JB . Fractures of the distal humerus. Northup Clin North Am 2000Jan; 31(1) :103-113.
8.Agarwal,Abbas M,Sherwani MK,Huda N,Azom Q,HashmatA Management of type C intercondylar fractures of lower end humerus in adults: A clinical study.J Indian Med Assoc. 2006 Jun;104(6):322, 324.
9. 马维虎等,C 型肱骨髁间骨折的手术治疗 。实用骨科杂志 2004 年 6 月,第 10 卷,第 3 期 ,193-194。
10.张弛等,三头肌劈开和尺骨鹰嘴截骨入路治疗肱骨髁间骨折的疗效比较,中华创伤杂志 2005 年 3 月第 21 卷第 3 期 ,173-175.
11.吴英华,张铁良。经鹰嘴截骨入路治疗肱骨髁间骨折。中华骨科杂志,1997,8:504。
12. Archdeacon MT Combined olecranon osteotomy and posterior triceps splitting approach for complex fractures of the distal humerus J Orthop Trauma. 2003 May;17(5):368-73.
13. Ozer H, Solak S,Tutanli S,Baltaci G,Colakoglu T,Bolukbasi S.Intercondylar fractures of the distal humerus treated with the triceps- ref- lecting anconeus pedicle approach Arch Orthop Trauma Surg. 2005 Sep;125(7):469-74. Erratum in: Arch Orthop Trauma Surg. 2006 Oct;126(8):574.
14. 明新杰,明立功,明新忠,张全金。三种入路治疗肱骨髁间 C 型骨折疗效比较。骨与关节损伤杂志 2000 年3 月第 15 卷第 2 期,136-137。
15. 丁卫华,刘 明。肱三头肌切断造瓣对肘关节功能影响的研究 骨与关节损伤杂志,2003, 18:337。
16. 张弛,姚振均,陈峥嵘,三头肌劈开和尺骨鹰嘴截骨入路治疗肱骨髁间骨折的疗效比较。中华创伤杂志2005年 3 月第 21 卷第 3 期 ,2005,21,3 ,173-175。
18. 林本丹,钟志刚,邱雪立等,38 例肱骨髁间骨折的治疗方法及手术入路探讨。中国创伤杂志, 2000 , 16:750-751。
19. Ek ET,Goldwasser M,Bonomo AL.Functional outcome of complex intercondylar fractures of the distal humerus treated through a triceps-sparing approach J Shoulder Elbow Surg. 2008 Feb 16;
20. 张贵林,李楠,尹明江,等。经肱三头肌两侧入路治疗肱骨髁间骨折。中华骨科杂志,2001,21:279-282。
21.陶玉平等,三种入路治疗成人肱骨髁间骨折疗效比较。骨与关节损伤杂志 2004 年 5 月第 19 卷第 5 期,328-329。
22. Schemitsch EH,Tencer AF,Henley MB.Biomechan- ical evaluation of methods of internal fixation of the distal humerus.J Orthop Trauma 1994 8(6): 468-475.
23. 曾青东等,AO 双钢板治疗肱骨髁间骨折疗效分析,骨与关节损伤杂志,2004 年 1 月 第 19 卷 第 1 期 23-24。
24.Gupta R,Khanchandane P.Intercondylar fractures of the distal humerus in adults: a critical analysis of 55 cases. Injury. 2002 Jul;33(6):511-5.
25.Helfe DL, Hotchkiss RN. Internal Fixation of the distal humerus: abiomechanical comparison of methods .J Orthop Trauma, 1990, 4:260
26.王友华等,三种内固定方法治疗肱骨髁间粉碎性骨折的疗效比较,中华创伤骨科杂志,2006 年 8 月第 8 卷第 8 期。
27. 张爽 李治伟 等,双钢板法治疗肱骨髁间骨折,中华骨科杂志 2005年 1月第 25 卷第1期 46-49。
28.吴冬灵等,双钢板法治疗肱骨髁问粉碎性骨折,中国骨与关节损伤杂志, 2007 年 7 月 第22卷 第7期598-598。
29.苗卫东等,Y型钛钢板内固定治疗成人肱骨髁间粉碎骨折. 中国矫形外科杂志,2005年7月第13卷第14期 1058-1059.
30. 黄兴力等,Y 形钢板内固定治疗肱骨髁间骨折,实用骨科杂志,第 11 卷,第 6 期,2005 年 12 月 534-535.
31.郑世春 白晋卓,Y 型钢板在肱骨髁间骨折中的应用,中国修复重建外科杂志2005年第19卷第4期277-277
32. 刘建斌等,双克氏针钢丝张力带固定治疗肱骨髁间骨折,中国骨伤,2006 年 1 月,第 19 卷,第 1 期, 38-38.
33. 张峡,梅芳瑞,等。加压螺钉治疗肱骨髁间 T 形或Y 形骨折 58 例报告,骨与关节损伤杂志,1998,13 (1):38-39.
34.吕琦等 ,中空螺纹钉双钢板内固定治疗肱骨髁间骨折,骨与关节损伤杂志,2005 年 5 月第 20 卷第 5 期,335-336。
35. 蔡建平等,国产可吸收螺钉治疗关节内骨折 30 例报告,中医正骨 2003 年 7 月第 15 卷第 7 期.45-46.
36. 杨晓平,同种异体骨螺钉治疗关节内骨折 47 例,中国中西医结合外科杂志,2003 年 8 月第 9 卷第 4 期。320-320.
37. 郭志民,翟文亮等,肘关节外固定架结合内固定治疗肱骨髁间骨折的生物力学评价 ,中国临床解剖学杂志, 2005 年第 23 卷第 4 期,427-430.
38. Mckee MD,Mehne DK, Jupiter JB, et al .Fracturesof the distal humerus. Browner BD. Skeletal trauma. 2nd ed. Philadelphia: WB Saunders,1998 .14384.
39. Hotchkiss RN.Fractures and dislocations of the elbow [A]. RocrwoodC A,Green D P,Bvcholz R W,eds.Fractures in Adults 4thde[C].NewYork: Lippincdl-Raven,1996.925.
40. 黄 雷,张 波,王满宜等,肱骨髁间骨折的手术治疗,中华骨科杂志,2001,21:158.
41. Helfet DL,Klien P,Anand N,Risen HS. ORIF of delayed unions and nonunions of distal humeral fractures. Surgical technique. J Bone Joint Surg Am. 2004 Mar;86-A Suppl 1:18-29.
42. 王思群,吴建国等,重建钢板固定和尺神经前置治疗肱骨髁间骨折,中华骨科杂志,2003 年 8 月第 23 卷第 8 期 474-478.
43. Dakouré PW,Ndiaye A,Ndoye JM,SanéAD.Posterior surgical approaches to the elbow: a simple method of comparison of the articular exposure. Surg Radiol Anat. 2007 Dec;29(8):671-674. Epub 2007 Oct 19.
44. Hewins EA,Gofton WT,Dubberly J,MacDermid JC.Plate fixation of olecranon osteotomies. J Orthop Trauma. 2007 Jan;21(1):58-62.
45 Gupta R, Khanchandani P. Intercondylar fractures of the distal humerus in adults: a critical analysis of 55 cases. Injury. 2002 Jul;33(6):511-5.
2. Greiner S ,Hass NP,Bail HJ. Outcome after open reduction and angular stable internal fixation for supra-intercondylar fractures of the distal humerus: preliminary results with the LCP distal humerus system. Arch Northup Trauma Surge. 2007 Aug 23.
3. Papaioannnou N ,Babis GC, Kalavritinos J etal. Operativetreatment of type C intra-articular fractures of the distal humerus:the role of stability achieved at surgery on final outcome. Injury1995 Apr,26(3)169-173.
4.Muller ME,Nazarian S,Koch P,etal:The ComprehensiveClassification of Fractures of LongBones. Berlin,Springer--Verlag, 1990.
5.Mehne DK, Jupiter JB: Fractures of the distal humerus. In Browner B , Jupiter JB , Levine A ,etaI(eds):Skeletal Trauma. Philadelphia, WB Saunders, 1991,1146.
6. 卢世璧 王继芳 王岩 陈继营主译 坎贝尔骨科手术学(第10版)3卷 (2896)
7.Ring D ,Jupiter JB . Fractures of the distal humerus. Northup Clin North Am 2000Jan; 31(1) :103-113.
8.Agarwal,Abbas M,Sherwani MK,Huda N,Azom Q,HashmatA Management of type C intercondylar fractures of lower end humerus in adults: A clinical study.J Indian Med Assoc. 2006 Jun;104(6):322, 324.
9. 马维虎等,C 型肱骨髁间骨折的手术治疗 。实用骨科杂志 2004 年 6 月,第 10 卷,第 3 期 ,193-194。
10.张弛等,三头肌劈开和尺骨鹰嘴截骨入路治疗肱骨髁间骨折的疗效比较,中华创伤杂志 2005 年 3 月第 21 卷第 3 期 ,173-175.
11.吴英华,张铁良。经鹰嘴截骨入路治疗肱骨髁间骨折。中华骨科杂志,1997,8:504。
12. Archdeacon MT Combined olecranon osteotomy and posterior triceps splitting approach for complex fractures of the distal humerus J Orthop Trauma. 2003 May;17(5):368-73.
13. Ozer H, Solak S,Tutanli S,Baltaci G,Colakoglu T,Bolukbasi S.Intercondylar fractures of the distal humerus treated with the triceps- ref- lecting anconeus pedicle approach Arch Orthop Trauma Surg. 2005 Sep;125(7):469-74. Erratum in: Arch Orthop Trauma Surg. 2006 Oct;126(8):574.
14. 明新杰,明立功,明新忠,张全金。三种入路治疗肱骨髁间 C 型骨折疗效比较。骨与关节损伤杂志 2000 年3 月第 15 卷第 2 期,136-137。
15. 丁卫华,刘 明。肱三头肌切断造瓣对肘关节功能影响的研究 骨与关节损伤杂志,2003, 18:337。
16. 张弛,姚振均,陈峥嵘,三头肌劈开和尺骨鹰嘴截骨入路治疗肱骨髁间骨折的疗效比较。中华创伤杂志2005年 3 月第 21 卷第 3 期 ,2005,21,3 ,173-175。
18. 林本丹,钟志刚,邱雪立等,38 例肱骨髁间骨折的治疗方法及手术入路探讨。中国创伤杂志, 2000 , 16:750-751。
19. Ek ET,Goldwasser M,Bonomo AL.Functional outcome of complex intercondylar fractures of the distal humerus treated through a triceps-sparing approach J Shoulder Elbow Surg. 2008 Feb 16;
20. 张贵林,李楠,尹明江,等。经肱三头肌两侧入路治疗肱骨髁间骨折。中华骨科杂志,2001,21:279-282。
21.陶玉平等,三种入路治疗成人肱骨髁间骨折疗效比较。骨与关节损伤杂志 2004 年 5 月第 19 卷第 5 期,328-329。
22. Schemitsch EH,Tencer AF,Henley MB.Biomechan- ical evaluation of methods of internal fixation of the distal humerus.J Orthop Trauma 1994 8(6): 468-475.
23. 曾青东等,AO 双钢板治疗肱骨髁间骨折疗效分析,骨与关节损伤杂志,2004 年 1 月 第 19 卷 第 1 期 23-24。
24.Gupta R,Khanchandane P.Intercondylar fractures of the distal humerus in adults: a critical analysis of 55 cases. Injury. 2002 Jul;33(6):511-5.
25.Helfe DL, Hotchkiss RN. Internal Fixation of the distal humerus: abiomechanical comparison of methods .J Orthop Trauma, 1990, 4:260
26.王友华等,三种内固定方法治疗肱骨髁间粉碎性骨折的疗效比较,中华创伤骨科杂志,2006 年 8 月第 8 卷第 8 期。
27. 张爽 李治伟 等,双钢板法治疗肱骨髁间骨折,中华骨科杂志 2005年 1月第 25 卷第1期 46-49。
28.吴冬灵等,双钢板法治疗肱骨髁问粉碎性骨折,中国骨与关节损伤杂志, 2007 年 7 月 第22卷 第7期598-598。
29.苗卫东等,Y型钛钢板内固定治疗成人肱骨髁间粉碎骨折. 中国矫形外科杂志,2005年7月第13卷第14期 1058-1059.
30. 黄兴力等,Y 形钢板内固定治疗肱骨髁间骨折,实用骨科杂志,第 11 卷,第 6 期,2005 年 12 月 534-535.
31.郑世春 白晋卓,Y 型钢板在肱骨髁间骨折中的应用,中国修复重建外科杂志2005年第19卷第4期277-277
32. 刘建斌等,双克氏针钢丝张力带固定治疗肱骨髁间骨折,中国骨伤,2006 年 1 月,第 19 卷,第 1 期, 38-38.
33. 张峡,梅芳瑞,等。加压螺钉治疗肱骨髁间 T 形或Y 形骨折 58 例报告,骨与关节损伤杂志,1998,13 (1):38-39.
34.吕琦等 ,中空螺纹钉双钢板内固定治疗肱骨髁间骨折,骨与关节损伤杂志,2005 年 5 月第 20 卷第 5 期,335-336。
35. 蔡建平等,国产可吸收螺钉治疗关节内骨折 30 例报告,中医正骨 2003 年 7 月第 15 卷第 7 期.45-46.
36. 杨晓平,同种异体骨螺钉治疗关节内骨折 47 例,中国中西医结合外科杂志,2003 年 8 月第 9 卷第 4 期。320-320.
37. 郭志民,翟文亮等,肘关节外固定架结合内固定治疗肱骨髁间骨折的生物力学评价 ,中国临床解剖学杂志, 2005 年第 23 卷第 4 期,427-430.
38. Mckee MD,Mehne DK, Jupiter JB, et al .Fracturesof the distal humerus. Browner BD. Skeletal trauma. 2nd ed. Philadelphia: WB Saunders,1998 .14384.
39. Hotchkiss RN.Fractures and dislocations of the elbow [A]. RocrwoodC A,Green D P,Bvcholz R W,eds.Fractures in Adults 4thde[C].NewYork: Lippincdl-Raven,1996.925.
40. 黄 雷,张 波,王满宜等,肱骨髁间骨折的手术治疗,中华骨科杂志,2001,21:158.
41. Helfet DL,Klien P,Anand N,Risen HS. ORIF of delayed unions and nonunions of distal humeral fractures. Surgical technique. J Bone Joint Surg Am. 2004 Mar;86-A Suppl 1:18-29.
42. 王思群,吴建国等,重建钢板固定和尺神经前置治疗肱骨髁间骨折,中华骨科杂志,2003 年 8 月第 23 卷第 8 期 474-478.
43. Dakouré PW,Ndiaye A,Ndoye JM,SanéAD.Posterior surgical approaches to the elbow: a simple method of comparison of the articular exposure. Surg Radiol Anat. 2007 Dec;29(8):671-674. Epub 2007 Oct 19.
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