锁定加压钢板内固定治疗老年肱骨远端骨折(英文)  

FIXATION OF DISTAL HUMERAL FRACTURE IN ELDERLY PATIENT BY LOCKING COMPRESSION PLATE

作　　者：陈志发 袁慧仪[2] 梁加利[2] 

机构地区：[1]香港玛丽医院矫形及创伤外科 [2]香港大学医学院矫形及创伤外科学系

出　　处：《中国修复重建外科杂志》2009年第11期1285-1289,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨锁定加压钢板(locking compression plate,LCP)内固定治疗老年肱骨远端骨折的疗效。方法2005年1月-2007年12月,采用切开复位LCP内固定治疗肱骨远端骨折24例。男4例,女20例;年龄60～93岁,平均75.5岁。致伤原因:摔伤22例,交通伤1例,击打伤1例。其中左侧及右侧各12例。按AO/ASIF分型:A2型12例,A3型2例,B1型2例,C1型2例,C2型2例,C3型4例。所有患者术前均摄正侧位X线片;CT三维重建诊断C型粉碎性骨折。受伤至手术时间1～6d,平均3d。术中经肱三头肌两侧入路(B型骨折患者除外),切开复位后LCP内固定肱骨远端骨折;C3型骨折患者行尺骨鹰嘴截骨。观察术后并发症发生情况,并于术后12个月行疼痛及肘关节活动度评定,并采用Mayo肘关节功能评分评价肘关节功能。结果术后24例患者均获随访,随访时间12～48个月,平均25个月。骨折均于6个月内愈合,平均4个月。术后12个月,20例(83%)无疼痛,4例(17%)中度疼痛;20例(83%)肘关节屈曲>100°;A、B、C型骨折Mayo肘关节功能评分平均分别为97、85、89分;A型骨折与B、C型骨折评分差异有统计学意义(P=0.034)。4例(17%)术后出现并发症。结论切开复位LCP内固定治疗老年肱骨远端骨折,术后肘关节功能恢复较好,骨折可达骨性愈合。Objective To review the outcomes of geriatric distal humeral fracture fixed with locking compression plate （LCP）. Methods From January 2005 to December 2007, 24 patients （20 females and 4 males） with distal humeral fracture underwent open reduction and internal fixation with LCP. Their average age was 75.5 years old, ranged from 60 to 93 years old. Fracture was caused by injury from fall in 22 cases, by traffic accident in 1 case, and by direct hit in 1 case. There were 12 cases of type A2, 2 cases of type A3, 2 cases of type B1, 2 cases of type C1, 2 cases of type C2, 4 cases of type C3 fractures according to AO/ASIF classification. X-ray films in AP and lateral view were taken preoperatively. CT scan with three dimensional reconstructions was done in more comminuted fracture only. Open reduction with triceps sparing technique was used in all except type B fracture, and olecranon osteotomy was considered only in more comminuted C3 fracture. The average interval between injury and operation was 3 days （range, 1-6 days）. Outcome measures included pain assessment, range of motion, and Mayo elbow performance score and findings at 1 year follow-up. Results The average length of follow-up was 25 months （range, 12-48 months）. All 24 fractures were healed within 6 months with an average of about 4 months. At 1 year follow-up, 83% （n=20） of patients felt no pain and 17% （n=4） of patients had mild pain; 83% of patient can gain a flexion range of more than 100% according to Mayo elbow performance score, the mean scores of type A, B and C fracture groups were 97, 85, and 89, respectively, and the post-operative performance of type A fracture was significantly better than that of type B and C （P=0.034）. Four patients had postoperative complications. Conclusion Open reduction and internal fixation of geriatric distal humeral fracture can achieve relatively good functional result and bony union despite of age.

关 键 词：肱骨远端骨折 锁定加压钢板 内固定 老年骨折 

分 类 号：R687.3[医药卫生—骨科学]