重建髁部治疗肱骨髁上髁间严重骨缺损性骨不连  

RECONSTRUCTION OF CONDYLE IN TREATMENT OF REFRACTORY CONDYLAR NONUNION AND DEFECT OF HUMERUS

作　　者：牛云飞[1] 张春才[1] 禹宝庆[1] 许硕贵[1] 王家林[1] 苏佳灿[1] 张鹏[1] 管华鹏[1] 刘欣伟[1] 李卓东[1] 

机构地区：[1]第二军医大学附属长海医院骨科,上海200433

出　　处：《中国修复重建外科杂志》2008年第1期36-39,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨肱骨髁部骨不连伴严重骨缺损的重建方法及临床效果。方法1998年9月-2005年9月,收治肱骨髁部骨不连伴严重骨缺损18例。男12例,女6例;年龄18～60岁。原始骨折按AO/ASIF肱骨髁部骨折分型:A3型5例,B1型2例,C2型4例,C3型7例。术前影像学检查证实肱骨髁部骨不连,髁部内外侧柱和/或髁间骨缺损,缺损骨量1～4cm2。肘关节活动度:伸5～65°,平均21.5°;屈85.0～123.5°,平均95.8°。根据改良Cassebaum评分系统,肘关节功能优1例,良4例,优良率为27.8%。受伤至本次手术时间为7～52个月,平均22.8个月。手术均采用尺骨鹰嘴截骨入路,取自体髂骨对缺损髁部进行重建,综合运用形状记忆加压接骨器、克氏针张力带、加压空心钉、解剖钢板、重建钢板等多种方式进行固定。结果术后切口均Ⅰ期愈合。18例获随访12～86个月,平均27.6个月。未见骨块移位、植入物松动及内固定断裂。X线片检查示骨不连端于术后4～8个月骨性愈合,平均5.7个月。1例术后4个月肘关节前方发现异位骨化。18例术后1年肘关节活动度:伸0～44.5°,平均11.4°;屈105.5～144.5°,平均128.6°。采用改良Cassebaum评分系统评定肘关节功能:优8例,良6例,中3例,差1例,优良率77.8%。结论自体髂骨可有效重建肱骨髁部的解剖形态,利用成骨力值的概念进行骨块间的加压固定可有效促进骨折愈合。髁部骨块的良好复位和有效固定,配合术后早期积极的功能锻炼,可使肘关节的功能得到明显改善。Objective To discuss the strategy of condylar reconstruction in the treatment of refractory condylar nonunion and defect of humerus. Methods From September 1998 to September 2005,18 patients with refractory condylar nonunion concomitant withdefect of humerus were treated. The series included 12 males and 6 females, aged 18 to 60 years. According to AO/ASIF system, primal fractures were classified, including 5 cases of type A3, 2 cases of type B1,4 cases of type C2 and 7 cases of type C3 fractures. Condylar nonunion and defect of humerus were confirmed by preoperative X-ray. Defective bone mass was 1-4 cm^2. The mean extension and flexion of elbow joint was 21.5°（5-65°） and 95.80（85.0- 123.5°） respectively. According to Cassebaum scoring system, the excellent and good rate was 27.8% （excellent in 1 case and good in 4 cases）. Time from injury to operation averaged 22.8 months（7-52 months）. All patients were operated with approach of olecranon osteotomy. Bone defect was reconstructed with il iac autograft. Shape memory compressive connector, Kirschner wire, cannulated nail, ana- tomic plates and reconstruction plates were used to fix. Results Eighteen patients were followed up 12-86 months （mean 27.6 months）. All the incisions healed by first intention. No bone block displacement,loosening or breakage of internal fixation occurred. The time of bone union averaged 5.7 months（4-8 months）. The mean extension and flexion of elbow joint were 11.4° （0-44.5°） and 128.6°（ 105.5-144.5°） 1 year after operation. Ectopicossification formed in 1 case at anterior part of elbow 4 months after operation. According to Cassebaum scoring system,the results were excellent in 8 cases,good in 6 cases, fair in 3 cases and poor in 1 case. The excellent and good rate was 77.8%. Condusion The shape of humeral condyle can be reconstructed with iliac autograft. Compressive internal fixation of bone block can promote bone union. Anatomical reconstruction, rigid internal fixation and early function exercise

关 键 词：肱骨髁 骨缺损 骨不连 重建 内固定 

分 类 号：R687.3[医药卫生—骨科学]