有限内固定联合超关节铰链外固定支架治疗成人肱骨远端C3型骨折的疗效分析  

EFFECTIVENESS OF LIMITED INTERNAL FIXATION COMBINED WITH HINGED SUPER-ARTICULAR EXTERNAL FIXATOR FOR TYPE C3 FRACTURE OF DISTAL HUMERUS IN ADULT

作　　者：徐龙[1] 赵思淳 吴仕舟 呙金海[1] 黄富国[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2015年第6期678-682,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨采用有限内固定联合超关节铰链外固定支架治疗成人肱骨远端C3型骨折的疗效。方法 回顾分析2007年9月-2012年11月采用有限内固定联合超关节铰链外固定支架治疗的37例肱骨远端C3型骨折患者临床资料,其中男22例,女15例;年龄22～66岁,平均43.6岁。致伤原因：交通事故伤24例,摔伤5例,高处坠落伤4例,重物压砸伤2例,机器伤1例,其他伤1例。开放损伤22例,闭合损伤15例。受伤至手术时间3～46 h,平均18 h。结果 术后发生针道反应3例,切口感染1例;其余患者切口均Ⅰ期愈合。36例患者获随访,随访时间9～48个月,平均25.4个月。术后发生3例异位骨化,骨折愈合后行松解手术。1例因术后形成慢性骨髓炎骨折未愈合;其余患者骨折均愈合,愈合时间6～14个月,平均9个月。1例术后12个月出现迟发性尺神经炎,行尺神经松解前移术后神经功能恢复正常。随访期间均未出现骨缺血性坏死,无肘关节不稳及内固定物松动、断裂等并发症发生。末次随访时,患肘平均活动度为屈105°、伸—25°、旋前69.2°、旋后75.6°。肘关节功能按Mayo肘关节功能评分（MEPS）和上肢功能评分（DASH）评分评价,获优22例,良8例,中4例,差2例,优良率83.3%;按Cassebaum肘关节功能评分,获优21例,良7例,可5例,差3例,优良率77.8%。结论 有限内固定结合超关节铰链外固定支架治疗成人肱骨远端C3型骨折疗效满意,并发症相对较少。Objective To investigate the effectiveness of limited internal fLxation combined with hinged super- articular external fixator to treat type C3 fracture of the distal humerus. Methods Between September 2007 and November 2012, 37 cases of type C3 fracture of the distal humerus were treated. There were 22 males and 15 females with an average age of 43.6 years （range, 22-66 years）. The causes were accident injury in 24 cases, falling injury in 5 cases, falling from height in 4 cases, heavy crush injury in 2 cases, machine injury in 1 case, and other injury in 1 case. There were 22 cases of open iniury and 15 cases of closed iniury. The time from injury to operation was 3-46 hours （mean, 18 hours）. Results Needle tract reaction and incision infection occurred in 3 cases and 1 case respectively, healing of incision by first intension was obtained in the other cases. Thirty-six patients were followed up 9-48 months （mean, 25.4 months）. Heterotopic ossification occurred in 3 cases after operation and no recurrence was found by release after fracture healing. Fractures healed in the other patients after 6-14 months （mean, 9 months） of operation except I patient who suffered chronic osteomyelitis. One patient had delayed ulnar neuritis at 12 months after operation, and the nerve function returned to normal after the ulnar nerve transposition. There was no bone ischemic necrosis, elbow joint instability, or loosening of internal fixation. At last follow-up, the average range of motion of injured elbow was 105.0° in flexion, -25.0° in extension, 69.2° in pronation, and 75.6° in supination. According to Mayo elbow joint function score （MEPS） and disability of arm shoulder and hand （DASH） score, the results were excellent in 22 cases, good in 8 cases, fair in 4 cases, and poor in 2 cases with an excellent and good rate of 83.3%; and according to Cassebaum elbow joint function score, the results were excellent in 21 cases, good in 7 cases, fair in 5 cases, and poor in 3 cases with an excellent and g

关 键 词：肱骨远端骨折 有限内固定 外固定支架 

分 类 号：R687.3[医药卫生—骨科学]