肱骨远端C型骨折手术治疗的研究进展  

Surgical treatment for distal humerus type C fractures

作　　者：胡彬[1] 刘煊文 黄家骏[1] HU Bin;LIU Xuan-wen;HUANG Jia-jun(Department of Orthpaedics,Chengdu 363 Hospital of Sichuan,Chengdu 610041,Sichuan,China.)

机构地区：[1]成都体育学院研究生院,四川成都610041 [2]成都363医院骨科,四川成都610041

出　　处：《中国骨伤》2018年第10期976-982,共7页China Journal of Orthopaedics and Traumatology

摘　　要：肱骨远端C型骨折是一少见而又复杂的关节内损伤,非手术治疗难以准确复位骨折和重建关节面,切开复位内固定则是目前最理想的治疗选择。尺骨鹰嘴截骨入路可以提供充足的术野显露,是最常用的手术入路,但存在截骨处不愈合、内固定失败等并发症。为避免牺牲鹰嘴的完整性,肱三头肌内外侧入路、肱三头肌翻转入路、肱三头肌-肘肌瓣翻转入路、肱三头肌劈开入路及肱三头肌腱膜舌形瓣入路等则应用到骨折的显露中,但不同入路的局限性,使得入路选择在术野暴露与伸肘功能受影响之间存在一定矛盾性。随着"双柱"理论的推广,双钢板固定C型骨折比单钢板具有显著力学优势。在体外生物力学试验中,即便平行双钢板较垂直双钢板更有优势,但目前尚不清楚两者在临床运用中是否存在差异。对于关节面无法重建的C型骨折,肘关节置换术可能是最终的选择,由于技术水平限制,其长期疗效还有待观察。Distal humerus type C fracture is a rare and complicated intra-articular injury. Non-surgical treatment is difficult to achieve accurately reduction and reconstruction of articular surface,while open reduction and internal fixation is the best treatment option. Olecranon osteotomy could provide adequate surgical exposure,and is the most commonly used surgical method,but complications such as non union osteotomy,internal fixation failure occurred. To avoid sacrificing integrity of olecranon,paratricipital approach,triceps reflecting approach,triceps reflectin ganconeus pedicle approach,triceps splitting and triceps tongue shaped flap approach have been applied to fracture revealed. However,there is a certain contradiction of choice between surgical exposure and extension function of elbow due to limitations of different approaches. With the promotion of ＂double-column＂ theory,double plates has significant mechanical advantages over single plates. Even if parallel double plate has more advantageous than vertical double-plate in vitro biomechanical experiments,it is not clear whether there is any difference between two methods in clinical application. Elbow arthroplasty may be the final choice for C-type fractures that could not be reconstructed on articular surface,but its long term efficacy remains to be observed due to technical limitations.

关 键 词：肱骨骨折 外科手术 关节成形术 置换 肩 

分 类 号：R687.3[医药卫生—骨科学]