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目的 探讨微创三切口双钢板固定技术治疗累及肱骨远端特别是肱骨远端、关节面的肱骨干中下段骨折的疗效.方法 2004年9月至2007年11月共收治6例累及肱骨远端的肱骨干中下段骨折患者,经肘关节内侧切口复位关节内骨折,空心螺钉固定.肱骨远端与骨干复位后,内侧柱用1/3管型钢板固定.肱骨干骨折采用闭合复位,于上臂前侧三角肌和肱二头肌之间另做小切口,制备此小切口与肘关节外侧切口之间的肌下隧道.将塑形的4.5 mm动力加压钢板经上臂小切口肌下插入,至肘关节外侧切口.钢板近端置于肱骨于前缘,远端置于外侧柱前外侧面,各至少3枚螺钉固定.术后采用Mayo肘关节功能评分系统评价结果.结果 6例患者术后获13~36个月(平均22.2个月)随访.骨折均获愈合,愈合时间为12~24周(平均19周).无医源性桡神经麻痹及内固定失败病例发生.肘关节活动度为110°~140°,平均130.8°.根据Mayo肘关节评分标准评定疗效:全部为优.结论 采用微创三切口双钢板技术治疗累及肱骨远端关节面的肱骨中下段骨折操作简单,可获得满意效果. 相似文献
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姜保国 《中国骨与关节外科》2008,1(2)
本文主要对肱骨远端骨折的治疗进展予以综述.累及关节面的肱骨远端骨折的处理相对困难,主要原因是其解剖特异.单纯外固定的保守治疗方法已被摒弃.对这类骨折,临床上越来越提倡解剖复位,牢固固定,早期的功能锻炼.具体的治疗方法依赖于术前对骨折的类型做出准确判断.目前该部位骨折分类仍以AO分型为主,治疗方法多种多样.主要的固定方法有双板内固定,适合C型完全关节内骨折.外固定架结合内固定,适合关节内骨折块粉碎,单纯内固定欠牢固,需要保护下进行功能锻炼的B型部分关节内骨折,或C型完全关节内骨折.全肘关节置换适合骨质疏松严重,骨折粉碎,难以复位和固定的高龄患者.对于小儿的肱骨远端骨折,可尝试克氏针内固定加外固定架的治疗方法. 相似文献
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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。 相似文献
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目的分析对肱骨远端C型骨折患者实施切开复位双锁定钢板内固定治疗的应用效果。方法将64例肱骨远端C型骨折并行切开复位内固定术的患者随机分为2组,每组32例。观察组实施双锁定钢板内固定,对照组实施"Y"型钢板内固定。比较2组手术治疗及术后肘关节预后情况。结果 2组术中出血量、手术时间、并发症比较,差异均无统计学意义(P0.05)。与对照组比较,观察组骨折愈合时间短,肘关节功能优良率高,差异均有统计学意义(P0.05)。结论应用切开复位双锁定钢板内固定治疗肱骨远端C型骨折,固定牢靠,骨折愈合快,并可促进患者术后肘关节功能的良好恢复。 相似文献
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肱骨远端低位通髁骨折在成年人中罕见,国内外报道较少,年龄呈双峰分布,多为老年人和年轻人。骨折线由内上髁延伸至外上髁,位置很低,为简单横行骨折,属于关节外、关节囊内骨折。标准肘关节正侧位X线片及CT平扫能够明确诊断。非手术治疗仅限于完全无移位骨折、无法耐受麻醉或晚期老年痴呆的患者。切开复位内固定是一线治疗方法,方式以平行及垂直双钢板为主,也有研究采用平行加垂直的"双柱4板"固定方式以及"十"字交叉双全螺纹螺钉固定。另外,有些特制后外侧柱钢板有外侧支撑作用,可置入横行螺钉。而全肘关节置换仅作为内固定失效后的补救措施。目前针对肱骨远端低位通髁骨折多为回顾性研究,证据等级较低。因此,亟需进行前瞻性及随机对照研究,针对不同内固定方式或全肘关节置换治疗低位通髁骨折的生物力学属性及临床疗效进行更进一步的研究。 相似文献
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目的 探讨Y形钢板内固定治疗肱骨远端骨折疗效.方法 对38例肱骨远端骨折患者应用Y形钢板内固定治疗,并对手术入路、内固定的应用、术后不良反应进行分析,对手术疗效进行评价.结果 38例均获随访,时间12~36个月,按照改良的Cassebaum评分系统评定术后肘关节功能:优22例,良11例,可5例,优良率为86.84%.出现桡神经挫伤1例,尺神经炎1例,肱肌异位骨化1例.结论 Y形钢板治疗肱骨远端骨折力求解剖复位,重建稳定;其具有固定牢固,术后可早期功能锻炼、并发症少等优点,疗效满意. 相似文献
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《中国医学文摘:外科学》2005,24(2):137-141
创伤性肩关节后方不稳定的关节镜表现与MR关节造影的对比研究;钩状钢板固定锁骨外端骨折和肩锁关节脱位;喙锁间环扎钢丝带治疗新鲜重度肩锁关节脱位;三角肌挛缩症术后远期疗效分析;老年肱骨近端骨折的内固定治疗;MIPPO技术LCP钢板内固定治疗老年肱骨近端骨折;AO重建钢板内固定治疗肱骨髁间粉碎性骨折;联合应用分叉状髓内钉和环抱片治疗肱骨干骺端骨折;全肘关节成形术在肘部肿瘤切除后重建中的应用;神经束支移位重建屈肘功能80例随访分析;肘管综合征尺神经皮下前置术疗效回顾性分析;交锁髓内钉治疗尺桡骨骨折的临床研究;老年桡骨远端骨折的治疗方法。 相似文献
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目的 探讨平行放置解剖型双钢板内固定治疗肱骨远端C型骨折的疗效.方法 2009年1月至2013年12月,对26例肱骨远端C型骨折患者进行切开复位、平行放置解剖型双钢板内固定治疗.根据国际内固定研究学会(AO)分型,C1型12例,C2型8例,C3型6例.术后1周开始功能锻炼.根据肘关节功能恢复情况、影像学检查及Aitken-Rorabeek肘关节功能评定标准对手术疗效进行评价.结果 所有患者均获得随访,随访时间为平均8.3个月(6~12个月),结果显示骨折均愈合,且肘关节功能恢复满意.根据Aitken-Rorabeek肘关节功能评定标准,优14例,良9例,可3例,总优良率为88.5%.所有患者均未发生术后感染、内固定失败等.结论 平行放置解剖型双钢板内固定治疗肱骨远端C型骨折疗效满意,其是治疗肱骨远端C型骨折的理想术式. 相似文献
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肱骨远端关节面剪切骨折是一种少见的肘部损伤,系暴力经桡骨头撞击肱骨远端,造成肱骨小头和滑车骨折所致。Bryan-Morrey分型常用于指导骨折治疗。保守治疗要达到骨折准确复位和维持复位困难,缺血性坏死发生率明显增加;切开复位内固定是治疗的理想选择,但手术入路和内固定材料的选择存在争议,文献中多推荐肘外侧入路和空心螺钉内固定。对特殊类型骨折,骨折块切除术和肘关节置换术可取得很好疗效;关节镜下复位内固定成为一种新型微创治疗方式。术后早期进行功能锻炼,是肘关节功能恢复的关键步骤。 相似文献
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S. O. Dietz K. E. Burkhart T. E. Nowak P. M. Rommens L. P. Müller 《European journal of trauma and emergency surgery》2012,38(6):605-615
Fractures of the distal humerus in adults are rare but challenging for the orthopaedic trauma surgeon. The bimodal distribution reflects the trauma mechanism. While distal humerus fractures are caused by high-energy traumata in young male adults, a fall from a standing height is the most common reason for humerus fractures among elderly females. As a rule, fractures of the distal humerus are treated surgically. In young patients, open reduction and internal fixation (ORIF) with anatomic locking plates are the gold standard. In elderly patients, reconstruction is not always possible, and total elbow arthroplasty (TEA) becomes necessary. The present article provides an overview of the current diagnostic and treatment recommendations. The current literature is reviewed and the results discussed. 相似文献
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The intraarticular fracture of the distal humerus in an elderly patient remains a challenge for trauma surgeons. In case of severe co-morbidities and/or osteoporosis stable fixation with screws and plates is difficult and in some cases can be impossible. Even if osteosynthesis is feasible the clinical outcome is still incalculable due to delayed or non-union of the fracture fragments. Endoprosthetic replacement of the elbow joint for comminuted distal humerus fractures has been used for almost 20 years. The clinical results are predominantly excellent or good and better predictable than those of osteosynthesis. There still is no guideline when a prosthesis for the elbow joint should be used. We reviewed the literature and outline the current recommendations for diagnostics and surgical therapy for distal humerus fractures in the elderly. 相似文献
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Dr. S.-O. Dietz T.E. Nowak K.J. Burkhart L.P. M��ller P.M. Rommens 《Der Unfallchirurg》2011,114(9):801-815
The intraarticular fracture of the distal humerus in an elderly patient remains a challenge for trauma surgeons. In case of severe co-morbidities and/or osteoporosis stable fixation with screws and plates is difficult and in some cases can be impossible. Even if osteosynthesis is feasible the clinical outcome is still incalculable due to delayed or non-union of the fracture fragments. Endoprosthetic replacement of the elbow joint for comminuted distal humerus fractures has been used for almost 20?years. The clinical results are predominantly excellent or good and better predictable than those of osteosynthesis. There still is no guideline when a prosthesis for the elbow joint should be used. We reviewed the literature and outline the current recommendations for diagnostics and surgical therapy for distal humerus fractures in the elderly. 相似文献
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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... 相似文献
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Alon Burg Michael Berenstein Joel Engel Tal Luria Moshe Salai Israel Dudkiewicz Steven Velkes 《International orthopaedics》2011,35(1):101-106
The aim of distal humerus fracture treatment is articular surface reduction and stable fixation for early mobilisation and
rehabilitation. This is usually performed by open reduction and internal fixation with plates. In the elderly osteoporotic
patient this treatment is difficult to achieve due to fixation failure in fragile bone. We present our experience with treatment
by closed reduction and external fixation with a non-bridging ring fixator in distal humerus fractures in elderly patients.
There were ten females, aged 70–89 (average 78.4). Fracture types (AO/ASIF) included three supracondylar fractures (type A)
and seven intercondylar fractures (type C). All patients were treated by closed reduction and external fixation with a non-bridging
ring fixator of the distal humerus and immediate postoperative mobilisation of the elbow. External fixation was removed on
an average of 72 days (range 62–90). All fractures united. Average time to union was 56 days. Average range of movement at
six months was 22° extension lag (range 15°–30°) and 115° flexion (range 110°–120°). Complications included one patient with
transient radial palsy and one patient with a superficial decubitus ulcer on the chest wall from the hardware. Minimally invasive
treatment by closed reduction and external fixation with a ring fixator is effective for treatment of fractures of the distal
humerus in elderly patients with osteoporotic bone. This treatment enables immediate mobilisation of the elbow, and allows
return to function. It should be considered an alternative to open reduction and internal fixation or total elbow replacement. 相似文献
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Results of total elbow arthroplasty in the treatment of distal humerus fractures in elderly Asian patients 总被引:3,自引:0,他引:3
BACKGROUND: Distal humerus fractures in elderly patients are difficult to treat as these fractures are often complicated by varying degrees of comminution intra-articular involvement and osteoporosis. We retrospectively reviewed the results of primary total elbow arthroplasty in the treatment of distal humerus fractures in seven patients followed for a minimum of 1 year. METHODS: Between July 2000 and June 2002, seven patients with distal humerus fractures were treated electively with total elbow arthroplasty using the semiconstrained Coonrad-Moorey elbow replacement prostheses. The Mayo Elbow Performance Score was used to assess the outcomes. RESULTS: The mean age of our patients was 72.9 years. The mean duration of postoperative hospitalization stay was 7.6 days. The average length of follow up was 24.9 months. Six of these patients had no pain, and one patient had mild pain. The mean arc of flexion was 88.6 degrees. Six elbows had excellent results, while 1 elbow had good result. The mean Mayo score was 94.3 points. One elbow developed blisters postoperatively but resolved with dressings and antibiotics. CONCLUSIONS: Our review suggests that total elbow arthroplasty can give good to excellent short term results when used in the treatment of distal humerus fractures in elderly Asian patients. 相似文献
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Fixation of fragility fractures with plates and screws often results in loss of fixation and need for revision surgery. Locking
plates and screw were introduced to improve fixation of fragility fractures and have been in use for a decade. This review
was conducted to compile evidence that locking plates and screws improve fixation of fragility fractures. A search of PubMed
was performed to identify biomechanical studies as well as clinical series of fragility fractures treated with locking plates.
Biomechanics papers had to use models of osteoporotic bone and had to directly compare locking plates with traditional plates.
Clinical studies included case series in which locking plates were applied to elderly patients with fractures of the proximal
humerus and periprosthetic distal femur fractures. Most studies are retrospective case series. Locking plates lead to greater
stability and higher loads to failure than traditional plates. When applied to proximal humerus fractures, uncomplicated healing
occurs in 85% of patients. Constant and Dash scores approach normal values. For distal femoral periprosthetic fractures, union
rates of 75% are reported with a malunion rate of 10%. Early evidence suggests that locking plates improve results of treatment
of proximal humerus fractures and distal femoral periprosthetic fractures in the elderly. Loss of fixation is associated with
failure to achieve stability at the fracture site. Principles of fracture fixation in osteoporotic bone defined prior to the
introduction of locking plates should still be applied. 相似文献
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目的 探讨双侧锁定钢板治疗老年患者C型肱骨远端骨折的临床效果.方法 回顾性分析笔者所在医院2005年4月~2009年1月采用切开复位双侧锁定钢板内固定治疗C型肱骨远端骨折老年患者14例,评价其效果.结果所有患者随访13~32个月,平均28个月.无内固定失效,骨折均愈合.采用改良Cassbaum评分系统评价,11例患者术后功能恢复优良.结论 切开复位双侧锁定钢板内固定治疗老年患者C型肱骨远端骨折能达到良好的临床效果. 相似文献
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Nauth A McKee MD Ristevski B Hall J Schemitsch EH 《The Journal of bone and joint surgery. American volume》2011,93(7):686-700
Distal humeral fractures in adults are relatively uncommon injuries that require operative intervention in the majority of cases. Dual plate fixation, with placement of a separate strong plate on each column and orientation of the plates either at 90° or 180° to each other, is indicated for all adult fractures involving both columns of the distal part of the humerus. Acute total elbow arthroplasty is the preferred treatment for elderly patients with a displaced, comminuted, intra-articular distal humeral fracture that is not amenable to stable internal fixation. Displaced coronal shear fractures of the distal humeral articular surface require operative fixation, most typically via a lateral approach. 相似文献
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Distal humerus fractures 总被引:1,自引:0,他引:1
Fractures of the distal humerus in adults have traditionally presented a treatment challenge for the orthopedic surgeon. The combination of anatomic complexity, multifragmentary comminution, and a short distal segment, often in the setting of osteoporotic bone, renders these fractures difficult to treat successfully and often make a full restoration of function uncertain. Multiple methods of treatment for these fractures have been described, including bracing, internal fixation, hemiarthroplasty, and total elbow arthroplasty. This article reviews the epidemiology and classification of these injuries and the numerous described fixation and arthroplasty techniques. The current treatment algorithm and authors' preferred method of internal fixation are also illustrated. Additionally, the treatment of these injuries in the elderly population and the complications of surgical treatment are reviewed. 相似文献