手术治疗肱骨远端粉碎性骨折的临床疗效观察
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摘要
目的探讨肱骨远端粉碎性骨折(即C3-3型肱骨髁间骨折)的治疗。
方法2006年8月～2008年5月间采用A0重建钢板等内固定治疗(AO/ASLF分型)C3-3型肱骨髁间骨折患者共25例,对随访资料完整的18例治疗结果进行分析。
结果18例随访时间8～21个月。所有骨折均愈合,愈合时间8～28周,肘关节平均活动范围为15°～123°。按Aitken和Rorabeek评分标准评价肘关节功能:优5例,良10例,可2例,差1例。
结论肱骨远端骨折根据骨折类型,骨折粉碎、移位程度选择合适的手术入路,早期手术、解剖复位和合理稳定内固定,配合术后早期进行功能锻炼,肱骨远端粉碎性骨折也可取得满意疗效。
Objective To study the treatment of distal comminuted fractures of humerus(just the C3-3 type intercondylar fractures of humerus).
Method August 2006 to May 2008 between a plate,screw or a combination of pinning such as in the treatment(AO / ASLF type) C3-3-humeral fracture patients with a total of 25 cases,to complete follow-up treatment The results of the 18 cases for analysis
Results 18 cases of follow-up time from 8 to 21 months.All fractures healed,the healing time from 8 to 28 weeks,the average scope of activities for the elbow 15°～123°.Aitken and the evaluation criteria Rorabeek elbow features:excellent in 10 cases,good in 5,fair in 2,and poor in 1.
Conclusion According to fracture of the distal humerus fracture type,fractures smash,choose a suitable degree of displacement of surgical approach,the early operation,anatomical reduction and reasonably stable internal fixation with early postoperative functional training,the distal humerus comminuted fracture can also achieve a satisfactory effect.
方法2006年8月～2008年5月间采用A0重建钢板等内固定治疗(AO/ASLF分型)C3-3型肱骨髁间骨折患者共25例,对随访资料完整的18例治疗结果进行分析。
结果18例随访时间8～21个月。所有骨折均愈合,愈合时间8～28周,肘关节平均活动范围为15°～123°。按Aitken和Rorabeek评分标准评价肘关节功能:优5例,良10例,可2例,差1例。
结论肱骨远端骨折根据骨折类型,骨折粉碎、移位程度选择合适的手术入路,早期手术、解剖复位和合理稳定内固定,配合术后早期进行功能锻炼,肱骨远端粉碎性骨折也可取得满意疗效。
Objective To study the treatment of distal comminuted fractures of humerus(just the C3-3 type intercondylar fractures of humerus).
Method August 2006 to May 2008 between a plate,screw or a combination of pinning such as in the treatment(AO / ASLF type) C3-3-humeral fracture patients with a total of 25 cases,to complete follow-up treatment The results of the 18 cases for analysis
Results 18 cases of follow-up time from 8 to 21 months.All fractures healed,the healing time from 8 to 28 weeks,the average scope of activities for the elbow 15°～123°.Aitken and the evaluation criteria Rorabeek elbow features:excellent in 10 cases,good in 5,fair in 2,and poor in 1.
Conclusion According to fracture of the distal humerus fracture type,fractures smash,choose a suitable degree of displacement of surgical approach,the early operation,anatomical reduction and reasonably stable internal fixation with early postoperative functional training,the distal humerus comminuted fracture can also achieve a satisfactory effect.
引文
[1]Jupiter JB,Neff U,Holzach P,etal.Intercondylar fracturesof the humerus:an operative approach.J Bone Joint Surg(Am),1985,67:226-239.
[2]Wang KC,Shuh NH,Hsu KY,et al.Intercondylar fractures of the distal humerus:routine anterior Subcutaneous transposition of the ulnar nerve in a posterior operative approach.J Trauma,1994,36:770-773.
[3]张秋林,赵杰,黄家林,等.肱骨远端关节内粉碎性骨折的内固定治疗[J].中国矫形外科杂志,2001,8(4):342-344.
[4]徐松,黄传俊,张明健.手术治疗肱骨髁间骨折的体会[J].骨与关节损伤杂志,2001,16(4):208-209.
[5]Ozer H,Solal S,Turanli S,et al Intercondylar fractures of the distal humerus treated with the triceps-reflecting anconeus pedicle approach [J].Arch Orth Orthop rrauma Surg 2005,125(7):469-474.
[6]Archdeacon MT.Combined olecranon osteotomy and posterior triceps splitting approach for complex fractures of the distal humerus[J].J Orthop Trauma 2003,17(5):368-373.
[7]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,2001,21:313-314.
[8]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,2001,21:158-162.
[9]王兴遥,于晓雯,唐明杰.双钢板法治疗肱骨髁间骨折.中华骨科杂志,2001,21:313-314.
[10]黄伟东。解剖型钢板治疗肱骨远端骨折。河北医学,1999,5(11):23-24.
[1]Jupiter JB,Neff U,Holzach P,etal.lntercondylar fracturesof the humerus:an operative approach.J Bone Joint Surg(Am),1985,67:226-239
[2]张峡,梅方瑞。加压螺钉治疗肱骨髁间T型或Y型骨折58例报告[J].骨与关节损伤杂志,1983,13(1):38-39.
[3]Korner J,Lill H,Muller LP,et al.Distal humerus fractures in elderly patients:results after open reduction and internal fixation[J].Osteoporos Int,2OO5,16(Suppl 2):S73-S79.
[4]游之海,马海鱼,代忠志,严伟。松质骨螺钉加双张力带法治疗肱骨髁间骨折疗效分析。中医正骨,2002,6:45-46.
[5]Houben PF,Bongers KJ,Wildenberg FA.Double tension hand osteosynthesis in suprar and transcondylar humeral fractures[J].Injury,1994,25(5):305-309.
[6]Helfet DL,Hotchkiss RN.Internal fixation of the distal humerus:a biomechanical comparison of methods[J].J Orthop Trauma,1990,4(3):260-264.
[7]丁彩田,闻兴高,张勤中,等。成人肱骨远端粉碎性骨折的治疗[J]。中国骨与关节损伤杂志,2005,20(5):337-338.
[8]黄伟东。解剖型钢板治疗肱骨远端骨折。河北医学,1999,5(111):23-24。
[9]郭志民,林斌,鲍鲲,等.4种内固定方法治疗肱骨髁部粉碎性骨折的疗效比较[J].临床骨科杂志,2005,8(4):309-312.
[10]张磊,郭丰霞.外固定架结合有限内固定治疗肱骨远端粉碎性骨折.滨州医学院学报,2005,4(2):130.
[11]门振武,王亦璁.肱骨髁间骨折开放复位内固定[J].中华外科杂志,1986,(2):115.
[12]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[J],2001,21(3):158-162.
[13]陈伯民,郭寿淇等.人工全肘关节置换10年以上疗效观察.安徽医学.1992, 13(1):37-38.
[14]Morry EF,et al.J Bone Joint Surg(Am).1983;65:330
[15]相大勇,顾立强.肱骨远端骨折并发症.中华创伤骨科杂志.2005.7(5):472-475.
[16]Morrey BF.Post-traumatic contracture of the elbow.Operative treatment,including distraction arthroplasty.J Bone Joint Surg (Am),1990,72:601-618.
[17]Savioe FH,Nunley PD,Field LD.Arthroscopic management of the arthritic elbow:Indications,technique and results.J Shoulder Elbow Surg,1999,8:214-219
[2]Wang KC,Shuh NH,Hsu KY,et al.Intercondylar fractures of the distal humerus:routine anterior Subcutaneous transposition of the ulnar nerve in a posterior operative approach.J Trauma,1994,36:770-773.
[3]张秋林,赵杰,黄家林,等.肱骨远端关节内粉碎性骨折的内固定治疗[J].中国矫形外科杂志,2001,8(4):342-344.
[4]徐松,黄传俊,张明健.手术治疗肱骨髁间骨折的体会[J].骨与关节损伤杂志,2001,16(4):208-209.
[5]Ozer H,Solal S,Turanli S,et al Intercondylar fractures of the distal humerus treated with the triceps-reflecting anconeus pedicle approach [J].Arch Orth Orthop rrauma Surg 2005,125(7):469-474.
[6]Archdeacon MT.Combined olecranon osteotomy and posterior triceps splitting approach for complex fractures of the distal humerus[J].J Orthop Trauma 2003,17(5):368-373.
[7]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,2001,21:313-314.
[8]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,2001,21:158-162.
[9]王兴遥,于晓雯,唐明杰.双钢板法治疗肱骨髁间骨折.中华骨科杂志,2001,21:313-314.
[10]黄伟东。解剖型钢板治疗肱骨远端骨折。河北医学,1999,5(11):23-24.
[1]Jupiter JB,Neff U,Holzach P,etal.lntercondylar fracturesof the humerus:an operative approach.J Bone Joint Surg(Am),1985,67:226-239
[2]张峡,梅方瑞。加压螺钉治疗肱骨髁间T型或Y型骨折58例报告[J].骨与关节损伤杂志,1983,13(1):38-39.
[3]Korner J,Lill H,Muller LP,et al.Distal humerus fractures in elderly patients:results after open reduction and internal fixation[J].Osteoporos Int,2OO5,16(Suppl 2):S73-S79.
[4]游之海,马海鱼,代忠志,严伟。松质骨螺钉加双张力带法治疗肱骨髁间骨折疗效分析。中医正骨,2002,6:45-46.
[5]Houben PF,Bongers KJ,Wildenberg FA.Double tension hand osteosynthesis in suprar and transcondylar humeral fractures[J].Injury,1994,25(5):305-309.
[6]Helfet DL,Hotchkiss RN.Internal fixation of the distal humerus:a biomechanical comparison of methods[J].J Orthop Trauma,1990,4(3):260-264.
[7]丁彩田,闻兴高,张勤中,等。成人肱骨远端粉碎性骨折的治疗[J]。中国骨与关节损伤杂志,2005,20(5):337-338.
[8]黄伟东。解剖型钢板治疗肱骨远端骨折。河北医学,1999,5(111):23-24。
[9]郭志民,林斌,鲍鲲,等.4种内固定方法治疗肱骨髁部粉碎性骨折的疗效比较[J].临床骨科杂志,2005,8(4):309-312.
[10]张磊,郭丰霞.外固定架结合有限内固定治疗肱骨远端粉碎性骨折.滨州医学院学报,2005,4(2):130.
[11]门振武,王亦璁.肱骨髁间骨折开放复位内固定[J].中华外科杂志,1986,(2):115.
[12]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[J],2001,21(3):158-162.
[13]陈伯民,郭寿淇等.人工全肘关节置换10年以上疗效观察.安徽医学.1992, 13(1):37-38.
[14]Morry EF,et al.J Bone Joint Surg(Am).1983;65:330
[15]相大勇,顾立强.肱骨远端骨折并发症.中华创伤骨科杂志.2005.7(5):472-475.
[16]Morrey BF.Post-traumatic contracture of the elbow.Operative treatment,including distraction arthroplasty.J Bone Joint Surg (Am),1990,72:601-618.
[17]Savioe FH,Nunley PD,Field LD.Arthroscopic management of the arthritic elbow:Indications,technique and results.J Shoulder Elbow Surg,1999,8:214-219