摘要
目的探讨老年患者肱骨髁间骨折经尺骨鹰嘴截骨手术内固定的疗效,并与行保守治疗的老年患者进行比较.方法对2006年7月至2009年7月收治的34例老年肱骨髁间骨折进行回顾性分析,男17例,女20例,年龄60～79岁,平均68.2岁.Riseborough分型,Ⅰ型6例,Ⅱ型11例,Ⅲ型12例,Ⅳ型5例.其中,22例经尺骨鹰嘴截骨行双侧钢板固定治疗,其余患者拒绝手术或不能耐受麻醉,6例在臂丛麻醉下手法复位石膏夹板固定,6例以石膏夹板固定前臂吊带悬吊制动但未行手法复位.术后功能采取Mayo肘关节评分(MEPS)、上肢肩手功能障碍评分(DASH)进行评价.结果所有患者平均随访25.7月,最短12.6月,最长35.8月.手术病例22例,Ⅰ型2例,Ⅱ型6例,Ⅲ型10例,Ⅳ型4例,Mayo评分为50～94分,平均77.23分,优5例,良10例,可3例,优良率为68.2%.DASH评分值为24.7分.保守病例12例,Ⅰ型4例,Ⅱ型5例,Ⅲ型2例,Ⅳ型1例,Mayo评分为40～90分,平均65.58分,优1例,良4例,可2例,优良率为45.4%.DASH评分值为46.6分.并发症包括3例肱骨髁上延迟愈合,1例鹰嘴骨不连,2例严重的肘关节僵硬,1例内固定失效,2例尺神经麻痹.两组Mayo评分及DASH评分比较差异有统计学意义.结论经尺骨鹰嘴截骨双钢板内固定治疗老年肱骨髁间骨折比保守治疗获得较好的关节功能恢复,但手术治疗在老年患者严重骨质疏松且骨折粉碎严重时需要慎重.
Objective To investigate the therapeutic effects of surgical treatment by approach of olecroanon osteotomy on intercondylar fracture of humerus in elderly patients and compared with expectant treatment.Methods We retrospectively analyzed the data of 34 elderly patients with intercondylar fracture of humerus from July 2006 to July 2009,including 17 male and 17 female patients,aged from 60 to 79,average 68.2.According to Riseborough classification,there were 6 patients with type I,11 patients with type II,12 patients with type III and 5 patients with type Ⅳ.22 patients were given olecroanon osteotomy approach with double plate,and other patients didn＇t receive this operation,6 patients received manual reduction and plaster splintage under brachial plexus anesthesia,and 6 patients were given mitella treatment before plaster splintage whithout manual reduction.The therapeutic effects were evaluated with MEPS and DASH scoring system.Results All patients were followed up for 12.6 to 35.8 months,average 25.7 months.Among 22 patients received surgical treatment,2 patients with type I,6 patients with type II,10 patients with type III and 4 patients with type Ⅳ.The Mayo scores were 50～94,average 77.23,there 5 cases in excellent recovery,10 cases in good recovery,and 3 cases in general recovery,the excellent and good rate was 68.2%.The DASH score was 24.7.Among 12 patients with expectant treatment,4 patients with type I,5 patients with type II,2 patients with type III and 1 patient with type Ⅳ.The Mayo scores were 40～90,average 65.58,there 1 case in excellent recovery,4 cases in good recovery,and 2 cases in general recovery,the excellent and good rate was 45.4%.The DASH score was 46.6.The complications included 3 cases of delayed union in condyle of humerus,1 case of olecranon bone non-union,2 cases of anchylosis in elbow joint,1 case of failure in internal fixation and 2 cases of ulnar nerve paralysis.There was statistically significant difference in Mayo score and DASH score between two groups.Conclusion Olecroanon osteotomy approach and internal fixation with double plate has better effects on the recovery of joint function of elderly patients with intercondylar fracture of humerus than expectant treatment,but surgical treatment should be carefully considered for elderly patients with comminuted fracture and sever osteoporosis.
出处
《昆明医学院学报》
2011年第7期110-114,共5页
Journal of Kunming Medical College
关键词
肱骨
髁间骨折
鹰嘴
截骨
骨质疏松
比较
Humerus
Intercondylar fracture
Olecranon
Osteotomy
Osteoporosis
Comparison
