Kaplan入路结合微型锁定钢板治疗肱骨远端冠状面骨折  

Surgical treatment of displaced coronal shear fractures of the distal humerus in adults through Kaplan approach combined with micro locking plate

作　　者：段鑫[1] 邹敏 王俊博 姚晓克[1] 陈志超[1] 李志力[1] 李建华[1] 胡江海[1] Duan Xin;Zou Min;Wang Junbo;Yao Xiaoke;Cheng Zhichao;Li Zhili;Li Jianhua;Hu Jianghai(Department of Orthopedics,Chengdu First People's Hospital,Chengdu 610041,China)

机构地区：[1]成都市第一人民医院骨科,610041

出　　处：《中华肩肘外科电子杂志》2018年第4期260-265,共6页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：成都市科技惠民技术研发项目(201344)

摘　　要：目的探讨Kaplan入路结合微型锁定钢板治疗肱骨远端冠状面骨折的临床疗效。方法对我科2012年3月至2016年12月收治的肱骨远端冠状面骨折患者进行回顾分析,共11例患者采用Kaplan入路,结合微型锁定钢板固定治疗方法。按Dubberley分型:IA型2例、IB型1例、ⅡA型3例、ⅡB型3例、ⅢA型1例、ⅢB型1例。术后复查肘关节摄片,了解关节面复位及内固定情况,门诊随访患者肘关节功能及骨折愈合情况。结果所有11例患者均获得随访,无血管神经损伤,其中1例发生内侧异位骨化,经早期干预后未进展。结论肱骨远端冠状面骨折采取外侧Kaplan入路,可充分显露关节面骨折块及骨折线,对于骨折复位及固定显露较好,可获得微型钢板稳定固定,术后患者可进行早期功能锻炼,肘关节功能恢复较好。Background The coronal shear fracture of distal humerus is intra-articular fracture that involves radial head and trochlear.This type of fracture has low incidence,accounting for 0.5%to 1.0%of all elbow fractures.Due to the controversy of treatment,more attention has been paid in recent years.Methods 1.Research object:From March 2012 to December 2016,11 patients(7 males and 4 females)with coronal shear fractures of distal humerus were treated with Kaplan approach combined with micro locking plate.The age ranged from 19 to 54 years with an average of 37.8 years.Causes of injury:5 cases of fall damage;3 cases of high falling injury;3 cases of traffic accident.Two patients had humeral head fractures,and one patient had radial head fractures and avulsion fractures of triceps tendon.According to Dubberley classification,there were 2 cases of IA,1 case of type IB,3 cases of type IIA,3 cases of type IIB,1 case of type IIIA and 1 case of type IIIB.The time from injury to surgery ranged from 5-10 days,and the mean time was 7.2 days.2.Operative methods:The examinations including elbow joint X-ray film of anteroposterior and lateral views,CT scan and reconstruction of coronal and sagittal shears were conducted preoperatively to determine the fracture site,the degree comminution and the displacement.As such,the individualized surgical plan was designed.The operation was performed under brachial plexus block or general anesthesia.The patient was placed in supine position,and the balloon tourniquet was used as well.The lateral Kaplan approach for elbow joint was commonly used,and the Kocher approach was adopted at the same incision for patients with humeral head fractures.This approach was made approximately 3 cm proximal to the lateral epicondyle of humerus along superior condylar crest.It went down across lateral epicondyle and bent back toward the posterior edge of ulna.Through the gap between anconeus,common extensor tendon and extensor carpi ulnaris muscle,the elbow extensor muscle was sharply separated from the lateral e

关 键 词：Kaplan入路 肱骨远端 冠状面骨折 微型钢板 

分 类 号：R687.3[医药卫生—骨科学]