铰链式超关节外固定器结合有限内固定治疗肘部骨折的临床观察  

The clinical research on the technique of limited internal fixation combined with hinged super-articular external fixator for the elbow fracture

作　　者：辛景义[1] 魏万富[1] 鲁杰[1] 张铁良[1] 

机构地区：[1]天津医院创伤骨科,300211

出　　处：《中华骨科杂志》2004年第6期334-337,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨铰链式超关节外固定器治疗肘部骨折的临床价值。方法2001年3月～2002年11月,铰链式超关节外固定器结合有限内固定治疗肘部骨折患者10例,男8例,女2例;年龄22～46岁,平均35岁。4例为肱骨髁间骨折,均为RiseboroughⅣ型骨折,后正中入路,将尺骨鹰嘴凿断连同肱三头肌向近端翻起,将骨折复位后用多枚松质骨螺钉或骨片钉固定;2例为尺骨冠状突骨折伴肘关节脱位,1例ReganⅢ型骨折,骨折块超过冠状突50%,用螺钉固定,另1例ReganⅡ型骨折,骨折块不足冠状突50%,先在骨折近端钻孔,用丝线穿过此孔缝合远端及关节囊;2例为MasonⅣ型桡骨头骨折伴肘关节脱位,采用肘关节外侧入路,1例因骨折块很小无法固定,行桡骨头切除,1例将较大骨折块(约占桡骨头总面积2/3)固定,其余部分切除;2例为尺骨鹰嘴骨折伴肘关节脱位,采用钢丝张力带固定。结果10例患者全部获得随访,随访时间6～18个月,平均12个月。根据Morrey制定评估指数,优6例,良3例,可1例,优良率90%。术后伤口一期愈合8例,2例开放性骨折伤口延迟愈合。结论铰链式超关节外固定器结合有限内固定治疗肘部骨折不但可以辅助固定,允许关节早期活动,而且可以明显恢复关节功能。Objective To assess the clinical value of limited internal fixation combined with hinged super-articular external fixator for the treatment of elbow fracture. Methods 10 patents with elbow fracture were treated with hinged external fixator from March 2001 to November 2002. It involved 8 males and 2 females, aged from 22 to 46 years. There were 4 humeral intercondylar fractures of Riseborough type Ⅳ, the fractures were fixed with few cancellous or interfacial screws through the postero-medial approach, the olecranon and the attached triceps were reflected proximally after the olecranon osteotomy. Among the other 6 severe fracture-dislocations of the elbow, 2 complicated with fracture of the coronoid process; 1 fracture of the Regan type Ⅲ, whose fragments were over 50% of the coronoid process, was fixed with screws; another 1 fracture of the Regan type Ⅱ, whose comminution was less than 50%, was sutured with the joint capsule from proximal to distal part; 2 combined with radial head fracture of Mason type Ⅳ, both selected the lateral elbow approach, 1 with resection because of comminution, the other was fixed nearly the 2/3 of its whole dimension; and 2 with olecranon fracture were fixed with tension-band wire. Results All 10 patients were available at final follow up, the mean duration was 12 months (range, 6-18 months). According to the Morry scoring system, there were 6 excellent, 3 good, 1 fair, and the effective rate was 90%. 8 cases united in the first-stage, the other 2 achieved delayed union because of open fracture. Conclusion The technique of hinged external fixator for the fractures around elbow not only can help to stabilize the fractures but also allows early rehabilitation. In comparison with other methods, it can better improve the function of elbow, so it is an effective treatment for this kind of injury.

关 键 词：铰链式超关节外固定器 有限内固定 治疗 肘部骨折 临床观察 

分 类 号：R687[医药卫生—骨科学]