摘要
目的探讨肱骨远端C型骨折的手术治疗方法及疗效。方法自1997年1月至2002年12月,手术治疗肱骨远端C型骨折30例。男11例,女19例;年龄16～67岁,平均41岁。左侧13例,右侧17例。开放骨折9例,其中GustiloⅠ型5例,Ⅱ型4例;闭合骨折21例。致伤原因:摔伤21例,交通伤7例,其他2例。合并其他部位损伤4例,其中桡骨远端骨折2例,肋骨骨折1例,肱骨外科颈骨折1例。按照AO/ASIF分型标准:C1型4例,C2型14例,C3型12例。对本组资料的手术入路、手术操作时间、出血量、内固定方式、肘关节功能及并发症等进行回顾性研究。在30例中,21例采用尺骨鹰嘴关节外截骨入路,9例采用肱三头肌舌形瓣入路。双钢板内固定17例,双张力带内固定13例。受伤至手术时间为0～17d,平均7d。结果所有患者均获得随访,时间6～62个月,平均28.5个月。肘关节功能按Morrey评定标准进行评定,优23例,良4例,差3例。结论尺骨鹰嘴关节外截骨入路具有暴露充分,不损伤关节面,利于截骨部骨折的愈合,后期肘关节稳定等优势。骨折应采用双钢板或双张力带进行双柱固定。双克氏针张力带内固定手术操作简单、时间短、出血少、固定可靠,如掌握恰当的适应证,其疗效与双钢板固定相近,是一种较好的内固定方法。
Objective - To evaluate the surgical management and its results of type C fractures of distal humerus. Methods From .lanuary 1997 to November 2002, 30 patients of type C fractures of distal humerus were treated surgically. There were 11 males and 19 females with mean age of 41 years （range 16- 67 years）. Thirteen fractures occurred in left extremity and 17 in the right. Nine patients suffered open frac- ture, including Custilo type I fracture in 5, and type lI in 4 cases. Twenty-one patients suffered closed frac- ture. The fracture were caused by falling injury in 21 cases, by traffic accident in 7 cases and by another cause in 2 cases. Associated injuries included： distal fracture of radius in 2 cases, fracture of rib in 1 case, and fracture of surgical neck of humerus in 1 case. According to AO/ASIF classification, type C 1 fracture was found in 4 cases, type C2 in 14 cases and type C3 in 12 cases. Of the 30 patients, 21 cases were operated with the approach of extra-articular osteotomy of olecranon, and 9 cases with the approach of liguliform flap of musculus triceps brachii. The fractures were reduced and fixed with dual-plates（DP） in 17 cases, and double tension bands （DTB） in 13 cases. The operation was performed in 0-17 days after injury with mean 7 days. Clinical data were recorded and reviewed retrospectively according to the surgical approach, operating time, amount of bleeding, types of internal fixation, function of the elbow and the complications. Results All the patients were followed up, with the duration from 6 to 62 months（mean, 28.5 months）. The function of the elbow was evaluated according to Morrey＇s scale, the results showed excellent in 23 cases, good in 4 cases, and poor in 3 cases. Conclusion The modified approach of extra-articular osteotomy of olecranon provide sufficient exposure without injury of articular surface, and the osteotomy healed easily with long-term stability. The type C fractures of distal humerus should be fixed with DP or DTB for two column fixation. DTB provide a new sufficient internal fixation with simple technical procedure, shortening operation time, less bleeding and reliable stability with similar results compared with DP fixation.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2005年第11期679-681,共3页
Chinese Journal of Orthopaedics
关键词
肱骨
骨折
回顾性研究
Humerus
Fractures
Retrospective studies
