肱三头肌劈开入路Y型钢板内固定治疗肱骨髁间粉碎性骨折

目的探讨肱三头肌劈开入路Y型钢板内固定治疗肱骨髁间骨折的手术方法及临床疗效。方法16例肱骨髁间粉碎性骨折采用肱三头肌劈开入路Y型钢板内固定术。结果所有患者随访1～3年,平均1.6年。骨折愈合时间2～6个月,平均3个月。根据改良的Cassebaum评分系统评定,优8例,良5例,可3例;优良率81.3%。结论经肱三头肌劈开入路Y型钢板内固定治疗肱骨髁间骨折术野显露充分,手术创伤小,内固定牢固,为早期功能锻炼,提高疗效创造有利条件。     

肱三头肌入路双柱固定成人肱骨远端C型骨折

目的探讨劈开肱三头肌入路双柱固定治疗成人肱骨远端C型骨折的临床疗效。方法2006年1月至2012年12月，45例成人肱骨远端C型骨折患者采用后正中劈开肱三头肌人路双柱固定治疗并早期行肘关节功能锻炼。结果45例患者均获随访，随访时间10～36个月，平均15个月，全部骨性愈合，肘关节功能良好。骨折平均愈合时间16周，参照Mayo肘关节功能评分系统评定，优18例，良14例，可9例，差4例，优良率71．1％。结论劈开肱三头肌入路双柱固定能提供坚强内固定，创伤小，操作简单，能早期功能锻炼，有利于肘关节功能的恢复，是治疗成人肱骨远端C型骨折的较好方法。     

经肱三头肌侧方入路垂直双钢板内固定治疗肱骨远端骨折

目的探讨经肱三头肌侧方入路垂直双钢板内固定治疗肱骨远端骨折的临床疗效。方法采用经肱三头肌两侧入路垂直双钢板内固定治疗32例肱骨远端骨折患者,根据AO分型,A3型13例,C1型12例,C2型5例,C3型2例。结果 32例均获随访,时间9~24(14±1.2)个月。骨折均愈合。患者术后患肘活动度:16例伸15°~屈130°,12例伸30°~屈120°,4例伸40°~屈90°。根据Cassebaum评分标准进行临床疗效评定:优16例,良12例,可4例,优良率87.5%。2例C3型骨折因暴露困难、关节面欠平整而出现术后较严重的创伤性关节炎。无感染、骨折不愈合和骨化性肌炎发生。结论经肱三头肌侧方入路垂直双钢板技术具有创伤小、固定可靠、可早期功能锻炼等优点,适用于治疗除C3型以外所有的肱骨远端骨折。     

肱骨远端关节内骨折手术治疗效果分析

目的分析肱骨远端关节内骨折的手术方法和常见并发症,评价手术治疗效果。方法2003年6月至2008年4月,收治肱骨远端关节内骨折患者43例,男30例,女13例;年龄18～76岁,平均39．3岁。其中AO／OTA分类B型18例,C型25例。分别采用经尺骨鹰嘴截骨入路、肱三头肌旁入路、劈开肱三头肌入路和肱三头肌远端舌形切断入路行肱骨远端关节内骨折切开复位及钢板内固定术,术后患者均未行外固定。术后1．5、3、6、12、24、36个月复查肘关节活动度和功能。结果术后开始主动及被动功能锻炼的时间为2～8d,平均3．6d。43例患者中36例获得随访,随访时间11～69个月,平均28个月。按照Mayo肘关节功能评分标准：优18例,良15例,可3例;优良率为91．2％。关节活动度74°～125°,平均95°。术后2例发生切口浅层感染,1例一过性尺神经损伤,1例复位不良。2例骨折延迟愈合,1例尺骨鹰嘴截骨处延迟愈合。结论肱骨远端关节内骨折的手术治疗效果良好。不同的肘关节后方手术入路方式中,经尺骨鹰嘴截骨入路的疗效评分优于经肱三头肌旁入路、劈开肱三头肌入路和肱三头肌远端舌形切断入路。     

掀起肱三头肌入路治疗大龄儿童肱骨远端C型骨折

目的 探讨大龄儿童肱骨远端C型骨折经掀起肱三头肌入路手术治疗的疗效. 方法 2008年3月至2011年11月对15例大龄儿童肱骨远端C型骨折患者采用经掀起肱三头肌入路切开复位钢板螺钉内固定治疗,男8例,女7例;年龄12～15岁,平均13.2岁.均为闭合性骨折.骨折按照AO分型:C1型8例,C2型5例,C3型2例.合并尺神经损伤2例.受伤至手术时间1～7d,平均3d.末次随访时按Aitken和Rorabeek标准评定肘关节功能. 结果 所有患者术后获8～24个月(平均12个月)随访,未发现骨折不愈合.无一例止点撕脱并发症发生,均未损伤肱三头肌肌纤维.末次随访时按Aitken和Rorabeek标准评定肘关节功能:优8例,良5例,可1例,差1例.结论 经掀起肱三头肌入路切开复位钢板螺钉内固定治疗大龄儿童肱骨远端C型骨折的疗效满意,避免了对尺骨鹰嘴的骨骺损伤,是治疗此类骨折的首选方法之一.     

经肱三头肌肘关节脱位入路与尺骨鹰嘴截骨入路内固定治疗AO-C3型肱骨远端骨折的比较

目的比较经肱三头肌肘关节脱位入路与尺骨鹰嘴截骨入路钢板螺钉内固定治疗AO-C3型肱骨远端骨折的疗效。方法回顾性分析自2010-08—2015-12诊治的48例C3型肱骨远端骨折,采用经肱三头肌肘关节脱位入路内固定23例(A组),采用尺骨鹰嘴截骨入路内固定25例(B组)。结果 A组手术时间较B组短,术中出血量较B组少,差异有统计学意义(P0.05)。48例均获随访6~24个月,平均12个月。末次随访时MEPS评分:A组(94.5±3.5)分,B组(89.5±2.5)分,A组明显高于B组,差异有统计学意义(t=2.032,P=0.038)。结论采用经肱三头肌肘关节脱位入路切开复位内固定治疗C3型肱骨远端骨折术中显露满意,骨折复位及内固定放置操作容易,术后疗效满意。     

掀起肱三头肌入路钢板固定治疗成人肱骨远端骨折

目的 掀起肱三头肌入路钢板固定治疗成人肱骨远端骨折的手术方法 和疗效.方法 对本院2007年10月至2010年12月,12例成人肱骨远端骨折应用掀起肱三头肌入路钢板固定治疗的手术入路、内固定的选择、术后的疗效进行回顾性分析,骨折按AO/ASIF分型法分型,其中B1型3例,B2型5例,B3型3例,C1型3例C2型1例.结果 12例成人肱骨远端骨折患者,参照改良关节功能评定标准Cassebaum评分系统,优5例,良5例,可1例,差1例,优良83.3%.结论 掀起肱三头肌两侧入路钢板固定治疗成人肱骨远端骨折临床上目前较理想的治疗方法.     

经肱三头肌两侧入路双钢板内固定治疗肱骨远端骨折

目的 探讨经肱三头肌两侧入路双钢板内固定治疗肱骨远端骨折的疗效。方法 采用经肱三头肌两侧入路双钢板内固定治疗33例骨质疏松性C3型肱骨远端骨折患者。记录手术情况、骨折愈合时间、肘关节及前臂活动度以及术后并发症发生情况，末次随访时采用MEPS评分评价功能恢复情况。结果 患者均获得随访，时间8～15个月。手术时间80～120(93.5±11.6)min。术后3～8个月X线片显示骨折内固定位置良好，骨折线模糊，可见连续性骨痂通过骨折线，提示骨折均愈合。术后无内固定松动或断裂、骨折复位丢失、骨折畸形愈合以及尺神经炎等并发症发生，4例发生骨化性肌炎。末次随访时，肘关节活动度：屈曲100°～140°,伸直5°～30°;前臂旋转活动度：旋前60°～80°,旋后55°～75°;肘关节MEPS评分为55～95分，其中优10例，良16例，可3例，差4例，优良率78.8%(26/33)。结论 经肱三头肌两侧入路能够为骨质疏松性C3型肱骨远端骨折双钢板固定提供良好的手术显露，避免尺骨鹰嘴截骨所带来的二次损伤，术后患者能够获得良好的肘关节功能。     

三种手术入路内固定治疗肱骨髁间骨折效果分析

目的分析三种手术入路内固定治疗肱骨髁间骨折疗效。方法对50例肱骨髁间骨折患者分别采用肱三头肌舌形瓣、肱三头肌劈开和尺骨鹰嘴截骨三种手术入路治疗。结果三种手术入路优良率分别为67%、56%和91%。结论三种手术入路各有优缺点,肱三头肌劈开适合C1型,经尺骨鹰嘴截骨入路适合C2和C3型肱骨髁间骨折,肱三头肌舌形瓣入路远端显露有限,不利于早期功能锻炼,效果相对较差。     

基于双柱理论的平行钢板固定技术在肱骨远端C型骨折治疗中的应用

目的探讨采用肘关节经三头肌舌形瓣入路或尺骨鹰嘴截骨入路钢板平行放置,固定肱骨远端内、外侧柱方法治疗肱骨远端C型骨折的临床疗效。方法对32例肱骨远端C型骨折采用肘关节经三头肌舌形瓣入路或尺骨鹰嘴截骨入路,AO解剖钢板平行放置,固定肱骨远端内、外侧柱,重建肱骨远端三角形框架结构的稳定性。结果 29例获得9~36个月的随访,骨折均愈合。按照Jupiter等肘关节功能评分标准:优12例,良14例,可2例,差1例,优良率89.7%。结论基于双柱理论的平行双钢板固定技术治疗肱骨远端C型骨折固定可靠,允许早期功能锻炼,疗效确切。     

A true triceps-splitting approach for treatment of distal humerus fractures: a preliminary report

BACKGROUND: The treatment of distal humerus fractures has traditionally been performed via a posterior approach and an olecranon osteotomy. The article reports the authors' clinical experience using a triceps-splitting approach for a consecutive series of patients with distal humerus fractures. METHODS: A consecutive series of 37 patients with 39 distal humerus fractures were treated with a triceps-splitting approach. All the fractures were managed with two-column fixation. RESULTS: A total of 33 patients (34 fractures) were available for follow-up evaluation over an average of 26 months (range, 13-48 months). There were five type A and 29 type C fractures. Five of the fractures were grade 1 open. There were three elbows with clinically asymptomatic valgus instability (<5 degrees at 30 degrees flexion) and one elbow with symptomatic varus instability. There was one case of heterotopic ossification, limiting motion; one transient ulnar nerve palsy; one severe infection requiring resection arthroplasty; and five nonunions. Four of the five nonunions involved patients older than 65 years. CONCLUSIONS: The use of a triceps-splitting approach to gain access to the distal humerus provided adequate exposure and had an acceptable complication rate. In addition to allowing for distal humerus reconstruction, it avoided the reported complications of olecranon osteotomy and is easily extensile if required.     

肱骨近端解剖接骨板治疗骨质疏松型后踝骨折

目的 探讨肱骨近端解剖接骨板(anatomy of the proximal humerus plate,APHP)治疗骨质疏松型后踝骨折的临床疗效.方法 选取我院2010年1月至2013年1月的18例骨质疏松型后踝骨折患者(其中1例为螺钉内固定失败患者行二次固定),采用小腿后内侧入路,应用肱骨近端接骨板内固定治疗,术后石膏固定4周,早期分阶段行功能康复锻炼.根据美国矫形足踝协会(AOFAS)踝与后足评分标准评估治疗效果.结果 伤口均一期愈合,无伤口感染、皮肤坏死等严重并发症,随访时间为12～24个月,平均16个月.X线检查示骨折于术后6.0～16.0个月愈合,平均9.2个月;根据AOFAS踝与后足评分标准进行功能评估:优12例,良5例,中1例,优良率为94.4％.结论 肱骨近端接骨板符合胫骨远端后外侧的解剖形态,接骨板与后踝贴合良好,覆盖面积大,通过加压,使得接骨板的作用力较均匀地分散在后踝骨折块上,避免了拉力螺钉内陷、松动等并发症,效果良好.     

锁定加压双接骨板治疗肱骨远端C型骨折

目的探讨切开复位LCP双接骨板内固定治疗肱骨远端C型(AO分型)骨折的临床疗效。方法对21例肱骨远端C型骨折采用切开复位LCP双接骨板内固定治疗。术后3 d开始保护性功能锻炼。按照Mayo肘关节功能评分系统(MEPS)及X线片评估术后疗效。结果患者均获随访,时间18～43个月,均骨性愈合。末次随访时肘关节平均活动度:屈伸87°±3°,屈曲114°±4°,伸直27°±6°,旋前65°±4°,旋后67°±5°。肘关节Mayo功能评分:55～100(87±4)分,优13例,良3例,可4例,差1例。术后并发症:4例出现暂时性尺神经麻痹,1例关节僵硬,1例有创伤性关节炎表现。结论切开复位LCP双接骨板内固定治疗肱骨远端C型骨折能提供坚强内固定,允许早期功能锻炼,临床疗效满意。     

Comparing approaches to expose type C fractures of the distal humerus for ORIF in elderly patients: six years clinical experience with both the triceps-sparing approach and olecranon osteotomy

Background

Although open reduction and internal fixation (ORIF) is a standard fracture treatment method, the optimal way to expose a fracture prior to ORIF is debated. We compared the effects of two exposure methods, the triceps-sparing approach and olecranon osteotomy, on the functional outcomes of ORIF-treated type C distal humerus fractures in elderly people.

Methods

From January 2006 to January 2011, 75 elderly patients with type C distal humerus fractures were treated with ORIF, and we retrospectively reviewed their medical records, radiographs, and follow-up charts to identify any complications. Patients’ Mayo Elbow Performance Score (MEPS) and range of motion were determined at their final clinic visit.

Results

Sixty-seven patients (89 %) attended the final visit. Of these patients, 36 received olecranon osteotomy and 31 received the triceps-sparing approach. For patients with type C1 and C2 fractures, we observed reductions in procedure times, blood loss, complication rates, and MEPS outcomes (all P < 0.01) with the triceps-sparing approach compared with olecranon osteotomy. Except for MEPS outcomes, all of these approach-related improvements were also statistically significantly for type C3 fractures (all P < 0.01). Overall, we did not observe any cases of fracture nonunion, implantation breakage or loosening, or elbow stiffening in our series.

Conclusions

In our study, we found better functional outcomes for type C1 and C2 distal humerus fractures that were exposed using the triceps-sparing approach rather than olecranon osteotomy. Even for the most complex type of fracture, C3 fractures, similar recoveries in elbow function were achieved using either approach.

Level of evidence

Level III.     

Locking plates in distal humerus fractures： study of 43 patients

Objective:The treatment of multifragmentary,intraarticular fractures of the distal humerus is difficult,even in young patients with bone of good quality.Small distal fragment,diminished bone mineral qu...     

经肱三头肌内外侧联合入路双钢板内固定治疗肱骨髁间骨折的临床研究

目的 探讨经肱三头肌内外侧联合人路(triceps-sparing approach,TSA)双钢板内固定治疗C1、C2型(AO/ASIF)肱骨髁间骨折的疗效.方法 对7例肱骨髁间粉碎性骨折(C1型3例,C2型4例)的患者,采用经肱三头肌内外侧联合入路,双钢板及髁间空心钉固定.结果 术后随访时间为8～18个月,平均15个月.根据Mayo评分系统(MEPS)评定:优5例,良2例.肘关节平均屈曲角度为(118.6±11.4)°,平均伸直角度丢失(22.9±12.1)°,肘关节携带角(20±5)°.无一例出现内固定松动、断裂.结论 经肱三头肌内外侧联合入路治疗C4、C2型肱骨髁间骨折是较理想的手术入路,具有暴露充分、骨折达到良好复位固定及术后早期康复等优点.     

合理运用钢板微创治疗胫骨远端骨折临床观察

目的：探讨根据胫骨远端骨折类型运用相应钢板微创治疗胫骨远端骨折的手术技术和临床疗效。方法：自2005年1月至2007年12月,胫骨远端骨折患者56例,其中男38例,女18例;年龄17～72岁,平均41岁。根据AO分型：A型28例,B型11例,C型17例。根据胫骨远端骨折类型,采用2个手术入路3种钢板（三叶草板35例,前侧L形解剖板12例,内侧LCP9倒）对胫骨远端骨折进行内固定治疗,并行随访和功能评价。结果：56倒患者获得随访,时间12～24个月,所有患者均达到骨性愈合,平均愈合时间为4个月（3～11个月）。按Mazur评价标;位：优51例,良5例：结论：在正确掌握手术技术的前提下,灵活选择合理钢板治疗胫骨远端骨折能够取得满意的临床疗效.     

Modified use of a proximal humeral internal locking system (PHILOS) plate in extra-articular distal-third diaphyseal humeral fractures

BackgroundSurgical treatment of extra-articular distal-third diaphyseal humeral fractures is controversial in terms of surgical approach and position of implant. The aim of this study is to evaluate the clinical and radiological outcomes of a modified application of the proximal humeral internal locking system (PHILOS) plate in extra-articular distal-third diaphyseal humeral fractures.Materials and methodsA total of 23 patients with extra-articular distal humerus fractures were treated using either open plating or the minimally invasive plate osteosynthesis (MIPO) technique with upside down application of the PHILOS plate. Fracture configuration, number of screws in the distal fragment, and time to union were analysed. Elbow range of motion, Mayo Elbow Performance Score (MEPS), and complications were evaluated at the final follow-up.ResultsFracture union was obtained in all patients at a mean postoperative time of 20.8 ± 2.9 weeks. The mean shortest and longest cortical lengths were 50.7 ± 14.0 mm and 85.2 ± 12.4 mm, respectively. The average number of screws in the distal humeral fragment was 5.6 ± 0.7. No statistically significant correlation was observed between the shortest cortical length and number of screws in the distal fragment (p = 0.224) or between the longest cortical length and the number of screws in the distal humeral fragment (p = 0.956). The average MEPS was 97.6 (range, 75–100). No postoperative complications that required reoperation were occured.ConclusionA modified anterior application of the PHILOS plate in extra-articular distal-third diaphyseal humeral fracture showed satisfactory outcomes, so it is an alternative when considering the ability to increase plate-screw density with locking screw fixation in a distal humeral fragment.Level of evidenceTherapeutic level IV, case series.     

Distal-third diaphyseal fractures of the humerus: choice of approach and surgical treatment

Purpose

Distal-third diaphyseal fractures of the humerus are often hard to treat due to location and pattern of the fractures, radial nerve injury, and quality of bone and age of patients. The aim of this retrospective study is to propose the best approach and the best surgical technique according to the pattern of extra-articular fracture of the distal humerus.

Methods

We have treated 37 fractures of the distal humerus between January 2010 and July 2015 classified according to the AO classification. There were 2 open fractures. We treated all fractures with open reduction and internal fixation with plates and screws. In 20 cases, we performed a posterior midline triceps-splitting approach, with patients in prone decubitus position; in 2 cases, the triceps-splitting approach with the patients in supine decubitus position; in 3 cases, the olecranon osteotomy approach in prone decubitus position; and in 12 cases, the lateral approach in supine decubitus position.

Results

Thirty cases had a medium follow-up of 6 months. We observe 2 post-operative radial nerve palsies healed in 5 months and 2 cases of non-union. The average time to union of remaining cases was 16 weeks (range 12–24). Elbow motility was complete in 25 cases, in 4 cases there was an extension loss of 5°, and in one case there was an extension loss of 10°.

Conclusions

The use of plates allows an anatomical fracture reduction, a better control of alignment of humerus and, with a rigid fixation, an early elbow mobilization. The best approach and the best surgical technique depend on the pattern of the fracture of distal humerus.

     

解剖型锁定钢板内固定治疗肱骨远端C型骨折

目的探讨应用解剖型锁定钢板内固定治疗C型肱骨远端骨折的疗效。方法肱骨远端C型骨折28例,按AO/ASIF分类:C1型10例,C2型15例,C3型3例;均采用采用尺骨鹰嘴截骨入路,解剖型锁定钢板内固定。受伤至手术时间平均5.8 d(2 h~10 d)。结果术后28例均获随访,平均20(2~30)月。骨折愈合时间平均3.5(2~10)个月。根据Cassebaum评分系统评定肘关节功能:优10例,良12例,可5例,差1例,优良率为78.6%,结论采用尺骨鹰嘴截骨入路,早期切开解剖复位、解剖型钢板内固定及早期有计划地康复训练治疗肱骨远端骨折,复位良好,固定可靠,能最大限度地恢复肘关节功能。