不同方法治疗肱骨髁部骨折比较  

Comparison of different treatments for humeral condylar fracture

作　　者：雷春湘 杨宏军[1] 易学夫 李三中[1] 赵而立 陈文革[1] 雷春爱 刘国平[2] 

机构地区：[1]怀化市中医院骨科,湖南怀化418000 [2]北京大学深圳医院骨科,广东深圳518036

出　　处：《临床骨科杂志》2003年第3期208-210,共3页Journal of Clinical Orthopaedics

摘　　要：目的　探讨不损伤伸肘装置的肘外侧入路克氏针钢丝内固定治疗肱骨髁骨折的疗效。方法　 2 13例肱骨髁上骨折、肱骨外上髁骨折和肱骨髁间骨折 ,分别采用 3种手术方法进行治疗。方法1:从肘外侧入路 ,即肱三头肌外侧与肱桡肌间隙入路 ,不切断肱三头肌 ,外侧克氏针钢丝固定 ,术后不用石膏托外固定。方法2 :肘后侧经肌入路 ,即肱三头肌切断入路交叉克氏针内固定 ,术后石膏托外固定。方法3 :肘后侧经骨入路 ,即尺骨鹰嘴截骨翻转入路 ,张力带钢丝固定 ,术后不用外固定。方法1,3 :早期功能锻炼 ,即术后 3～ 4d开始被动或主动屈伸关节。方法2 :术后 30d功能锻炼。结果　肱骨髁骨折采用方法1治疗 15 3例 ,优良率 98% ;用方法2 治疗 4 9例 ,优良率 81% ;用方法3 治疗 11例 ,优良率91%。方法1与方法2 ,3 比较 ,差异有显著性 (P <0 0 5 )。结论　方法1操作简单 ,损伤小 ,内固定可靠 ,可早期进行功能锻炼 ,术后功能恢复快 。Objective To investigate the effect of the treatment of humeral condylar fracture through lateral approach without invasion of the cubital extension mechanism. Methods 213 cases of supracondylar, intercondylar and external epicondylar fractures of humerus were operated with 3 methods, respectively. Method Ⅰ was through lateral approach from the intermuscular space between the triceps and the brachioradialis. The triceps were not cut off and the fracture was fixed with lateral tension band without external fixtion. Method Ⅱ was through posterior approach from triceps to the joint.The triceps were divided and the fracture was fixed by 2 cross pins with external fixation of cast. Method Ⅲ was through posterior approach from bone to the joint.The olecranon was osteotomed and reflected distally and the fracture was fixed with tension band without external fixation. The patients treated with Methods Ⅰ and Ⅲ began extension and flexion of the elbow in 3 or 4 days after operation, while those treated with Method Ⅱ began to exercise in 30 days after operation. Results The excellent and good rate were 98% in the 153 cases treated with Method Ⅰ and 81% in the 49 cases treated with Method Ⅱ and 91% in the 11 cases with Method Ⅲ. Method Ⅰ was the best of the three. ( P< 0 05 ). Conclusion Method Ⅰ has the advantages of easy manipulation, less trauma, reliable fixation, early exercises and rapid recovery, which can be effectively used in the treatment of humeral condylar fracture.

关 键 词：肱骨骨折 骨折固定术 肘外侧入路 克氏针钢丝内固定 治疗 

分 类 号：R683.41[医药卫生—骨科学] R687.32[医药卫生—外科学]