三种内固定技术治疗肱骨远端C型骨折的疗效比较  

Efficacy of three internal fixation methods for type C distal humeral fractures： a comparative study

作　　者：郭永智[1] 戴鹤玲[1] 赵建文[1] 李绍光[1] 彭城[1] 何红英[1] 樊辰[1] 刘智[1] 

机构地区：[1]北京军区总医院创伤骨科研究所,北京100700

出　　处：《中华创伤杂志》2013年第5期395-400,共6页Chinese Journal of Trauma

摘　　要：目的比较三种内固定技术治疗肱骨远端C型骨折的临床疗效。方法选择2003年1月-2010年10月采用双张力带固定、双钢板垂直固定和双钢板平行固定治疗的75例肱骨远端C型骨折患者，其中张力带固定（A组）22例，A0分型：C1型5例，C2型11例，C3型6例；双钢板垂直固定（B组）27例，AO分型：C1型4例，C2型13例，C3型10例；双钢板平行固定（C组）26例，A0分型：C1型7例，C2型10例，C3型9例。所有患者均取肘后正中切口，采用肱三头肌两侧或尺骨鹰嘴截骨人路。分别就内固定方式、肘关节伸屈活动度及并发症等指标进行分析，根据改良的Cassebaum评分系统进行功能评定。结果所有患者均获得平均18个月随访。骨折均获得骨性愈合，无一例发生伤口感染。最终随访时，肘关节伸屈活动度：A组为（122．06±13．13）°，B组为（118．70±12．37）°，C组为（119．90±11．79）°，三组之间差异无统计学意义（P〉0．05）。优良率：A组为82％，B组为85％，C组为85％（P〉O．05）。结论三种内固定技术治疗肱骨远端C型骨折均可获得较好的临床效果，符合肱骨远端生物力学要求。Objective To compare effects of three internal fixation techniques in treatment of type C distal humeral fractures. Methods The study involved 75 patients with type C distal humeral fractures undergone double tension band fixation （ Group A, n = 22）, vertical dual-plate fixation （ Group B, n = 27）, or parallel dual-plate fixation （ Group C, n = 26） between January 2003 and October 2010. According to AO classification of fractures, there were five patients with type CI, 11 with type C2 and six with type C3 in Group A; four with type C1, 13 with type C2 and 10 with type C3 in Group B; seven with type C1, 10 with type C2 and nine with type C3 in Group C. Bilateral approach through triceps brachii or olecranon osteotomy following median incision over posterior elbow was undertaken for all the patients. An analysis was made on indices like fixation modes, elbow range of extension and flexion, and complications. In addition, elbow function was assessed according to the modified Cassebaum scoring system. Results All patients were followed up for average 18 months, which showed bone union without wound infection. At the last follow-up, extension and flexion of the elbow was （ 122. 06 ± 13.13）° in Group A, （118. 70± 12. 37）° in Group B, and （119. 90±11. 79）°in Group C respectively, with no significant differences among groups（ P 〉 0.05 ）. Overall excellence rate was 82% in Group A, 85% in Group B and 85% in Group C, respectively （P 〉 0.05）. Conclusion All three internal fixation techniques can attain a good clinical outcome in treatment of type C distal humeral fracture and satisfy the biomechanical requests of distal humerus.

关 键 词：肱骨骨折 内固定器 钢板 

分 类 号：R687.3[医药卫生—骨科学]