复杂肱骨远端骨折手术治疗的临床探讨  

Clinical evaluation of operative treatment of complicated distal humerus fractures

作　　者：赵龙[1] 宋有鑫[1] 崔成喜 张宇轩[1] 张宝琦[1] 龚平[1] 武云鹤[1] 尚瑞松 陈宾[1] 

机构地区：[1]承德医学院附属医院骨外六科,067000

出　　处：《中华肩肘外科电子杂志》2014年第3期168-173,共6页Chinese Journal of Shoulder and Elbow(Electronic Edition)

摘　　要：目的：评价手术治疗复杂肱骨远端骨折的疗效。方法我院自2004年1月至2013年12月治疗肱骨远端骨折患者24例(AO/OTA 分型为 A3、B1、B2、C3型),根据不同的骨折分型采取个性化治疗,并对手术时间、术中出血量及术后肘关节功能进行评价。结果术后随访3~6个月,平均4.5个月。根据肘关节返修术后功能评价(Mayo Clinic),术后一周肘关节功能评分：良好12例,一般10例,较差2例,优良率为50.0%；术后3个月肘关节功能评分：良好15例,一般7例,较差2例,优良率为62.5%。AO/OTA 分型：A3型平均手术时间(186±45.9)min,平均术中出血量(161.1±69.7)ml,平均引流量(109.4±39.2)ml；B1、B2型平均手术时间(115±42.9)min,平均术中出血量(75.8±66.5)ml；平均引流量(17.0±28.2)ml；C3型平均手术时间(206.7±37.4)min,平均术中出血量(237.8±140.4)ml,平均引流量(132.8±17.9)ml。结论合理的手术入路及内固定方式结合早期功能锻炼有利于肱骨远端骨折患者术后肘关节功能的恢复,可提高肱骨远端骨折患者的治疗效果,减少并发症。Background Distal humeral fracture is a severe damage around the elbow joint,and is often seen in young adults.It accounts for 2% of all adult fractures and about 50% of all humerus fractures.It′s one of the fractures that is difficult to deal with.The types of distal humeral fracture are divergent. Distal humerus fractures are often comminuted which make operative reduction difficult.Secondary loss of reduction and elbow ankylosis are common postoperative complications. All these difficulties make the distal humerus fracture one of the unresolved problems in fracture treatment.This study is to evaluate the clinical outcome of complex distal humeral fractures treated by operation.Methods (1)General data:twenty-four cases of operative treated distal humerus fractures in author′s hospital from January 2004 to December 2013 were included in this study.There were 1 5 males and 9 females,aging from 1 7 to 73,averaged 41.AO/OTA Classification:A3:9 cases;B1, B2:6 cases;C3:9 cases.Two cases were combined with nerve injury.Two cases had histories of high blood pressure and diabetes.(2 ) Operative method:The patient was placed in the supine position,and the elbow to be operated on was positioned at 90°of abduction and supported on a lucent operating table.A pneumatic tourniquet was placed as proximally as possible on the arm.With the elbow flexed at about 60°,the first incision was made about 7 cm proximal to the tip of the medial epicondyle.In the initial cases,the ulnar nerve was isolated,released from the ulnar nerve groove, and protected carefully.In later cases,the nerve was only exposed.The medial and anteromedial side of the distal humerus was exposed through the opening between the brachial muscle and the medial intermuscular septum.The common origin of the flexor muscles was partially dissected and reflected distally,leaving a 5-mm strut to be re-sutured in situ at completion of surgery.The anterior capsule was incised.The articular surface of the trochlea was then exposed.A second incision was begun approxi

关 键 词：肱骨骨折 远端 手术治疗 疗效 

分 类 号：R687.3[医药卫生—骨科学]