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目的探讨影响肱骨髁间骨折手术后肘关节功能的相关因素。方法回顾性分析自2002-03—2014-01经手术治疗并获得完整随访的肱骨髁间骨折187例的临床资料。采用非条件Logistic回归分析评价可能影响术后肘关节功能的因素。结果单因素分析显示骨折类型、手术时机、内固定方式、手术入路有统计学意义;非条件Logistic回归分析显示骨折类型、内固定方式、手术入路是影响肘关节术后功能的独立因素。结论骨折类型、内固定方式及手术入路是影响肱骨髁间骨折术后功能的独立因素,因此,肱骨髁间骨折患者的骨折分型有助于骨科医生对手术的预后进行判断;选择恰当的手术方式有助于获得相对满意的手术疗效。 相似文献
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肱骨髁间骨折术后肘关节功能受限原因分析 总被引:15,自引:0,他引:15
目的探讨肱骨髁间骨折术后肘关节功能受限的原因。方法对1996年4月至2006年3月收治的57例肱骨髁间骨折内固定术后临床资料进行回顾性分析,探讨其中19例关节功能障碍的原因。结果平均随访32个月,骨折全部愈合。采用改良Cassebaum评分系统评定肘关节疗效,优28例,良10例,可13例,差6例。19例(33.3%)肘关节均有不同程度屈伸功能障碍。结论受伤机制、骨折类型、制动时间长、手术入路及内固定选择不当是导致肘关节功能障碍的主要原因。 相似文献
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自 198 7年 10月至 1996年 8月我院采用双张力带固定治疗肱骨髁间骨折 42例 ,经随访肘关节功能满意。报告如下 :1 临床资料 本组 42例 ,男 2 9例 ,女 13例 ;年龄 19~ 5 1岁 ;开放骨折5例 ,闭合骨折 37例。骨折类型 :根据Riseborough和Radin分类标准[1] :Ⅲ型 36例 ,Ⅳ型 6例。合并伤 :尺神经损伤 2例 ,桡神经损伤 1例。同一肢体骨折 3例 ,其中尺骨鹰嘴骨折2例 ,尺桡骨骨折 1例。2 治疗方法取肘后“U”形切口 ,沿肘关节远端两侧 ,在尺骨嵴上相连接 ,游离尺神经 ,牵开保护之。尺骨鹰嘴截骨 ,近端带有肱三头肌腱 ,向上… 相似文献
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肱骨髁间骨折是青壮年严重的肘部创伤 ,成年人多为粉碎性 ,因其移位明显及粉碎性程度高 ,闭合复位困难 ,而开放手术又缺乏有效的内固定 ,从而容易造成肘关节功能障碍、骨不连、畸形愈合等。我们从 1996年 6月~ 2 0 0 1年 6月采用双张力带法治疗肱骨髁间粉碎性骨折 18例 ,现报告如下。临床资料一、一般资料 本组男性 10例 ,女性 8例 ,年龄 2 2~ 68岁 ,平均 46岁。骨折类型按照 AO/ASIF分类 [1 ] ,均为 C型骨折 ,其中 C1 型 5例 ,C2 型 5例 ,C3型 8例。其中有 2例合并尺骨鹰嘴骨折。二、手术方法 本组患者均在伤后 5 h~ 10 d内手术 ,… 相似文献
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肱骨髁间骨折手术疗效分析 总被引:1,自引:0,他引:1
目的探讨肱骨髁间骨折手术疗效的影响因素。方法36例肱骨髁间骨折患者接受切开复位内固定手术治疗,用Mayo肘关节功能评分系统评分,分析骨折粉碎程度、手术时机、手术入路及功能锻炼时间等因素与肘关节功能评分之间的关系。结果本组随访时间20~38个月,平均26.5个月,其中尺神经麻痹3例,克氏针退出失效4例。按Mayo肘关节功能评分系统评分,优13例,良16例,中4例,差3例,优良率80.6%。结论肱骨髁间骨折术后疗效与骨折粉碎程度、手术时机、手术入路及功能锻炼时问等因素均有关。骨折粉碎愈重,则肘关节功能恢复愈差。早期手术、骨折解剖复位、牢固内固定、早期功能锻炼有利于肘关节功能恢复。手术入路对疗效也有影响。 相似文献
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复杂的肱骨髁间骨折三角张力带钢丝固定术 总被引:3,自引:0,他引:3
肱骨髁间骨折是青壮年严重的肘部损伤,由于损伤程度的差异,及所采用的治疗措施是否得当,其最终后果有很大差别。复杂的肱骨髁间骨折,多有骨折块的旋转移位和滑车关节面的严重损伤,非手术疗法往往不能取得满意的骨折复位。我院自1986~1995年间收治6例损伤严... 相似文献
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肱骨髁间骨折Y型钢板内固定术后康复指导 总被引:3,自引:0,他引:3
对19例肱骨髁间骨折病人行Y型钢板内固定术后早期应用肘关节功能康复器(CPM)功能锻炼,指导病人在不同时期的锻炼方法,并与主动训练相结合.结果13个月后随访,肢体功能评定优14例,良4例,一般1例(陈旧性骨折并有肘关节周围广泛性瘢痕增生),提示采用Y形钢板内固定结合CPM功能锻炼治疗肱骨髁间骨折具有固定牢靠、肘关节功能恢复满意的优点. 相似文献
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肱骨髁间粉碎性骨折术后肘关节功能受限原因分析 总被引:20,自引:0,他引:20
目的 分析肱骨髁间粉碎性骨折术后肘关节屈伸功能受限的原因。方法 1992年4月~2002年8月收治的32例内固定术后肱骨髁间粉碎性骨折临床资料的回顾性分析,探讨其中11例肘关节功能障碍的原因。结果 随访8~24个月,平均14个月,骨折全部愈合。采用李稔生肘关节疗效判断标准:优14例,良7例,一般8例,差3例。11例(34.4%)肘关节均有不同程度屈伸障碍。结论 致伤暴力大、损伤范围广、制动时间长、肘部感染及手术操作技术失误是导致肘关节功能障碍的主要原因。 相似文献
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Jitendra Nath Pal Prahas Biswas Avik Roy Sunit Hazra Somnath Mahato 《Indian Journal of Orthopaedics》2015,49(4):408-417
Background:Functional brace application for isolated humeral shaft fracture persistently yields good results. Nonunion though uncommon involves usually the proximal third shaft fractures. Instead of polyethylene bivalve functional brace four plaster sleeves wrapped and molded with little more proximal extension expected to prevent nonunion of proximal third fractures. Periodic compressibility of the cast is likely to yield a better result. This can be applied on the 1st day of the presentation as an outpatient basis. Comprehensive objective scoring system befitting for fracture humeral shaft is a need.Results:The results were assessed using 100 point scoring system where union allotted 30 points and 60 points allotted for angulations (10), elbow motion (10), shoulder abduction (10), shortening (5), rotation (5), absence of infection (10), absence of nerve palsy during treatment (10). Remaining 10 points were allotted for five items with two points each. They were the absence of skin sore, absence of vascular problem, absence of reflex sympathetic dystrophy (RSD), recovery of paralyzed nerve during injury and recovery of paralyzed nerve during treatment. Results were considered excellent with 90 and above, good with 80–89, fair with 70–79 and poor below 70 point. Results at 6 months were excellent in 43.94% (n = 29), good in 42.42% (n = 28), fair in 9.1% (n = 6), poor in 4.55% (n = 3). Union took place in 98.48% (n = 65) with an average of 10.3 weeks (range 6–16 weeks). 87.5% (n = 7) paralyzed radial nerve recovered. All wounds healed. Four patients had transient skin problem. One patient with mid shaft fracture had nonunion due to the muscle interposition.Conclusion:Modified functional cast brace is one of the options in treatment for humeral shaft fractures as it can be applied on the 1st day of the presentation in most of the situations. Simple objective scoring system was useful particularly in uneducated patients. 相似文献
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成人肱骨髁间骨折的治疗 总被引:1,自引:1,他引:0
目的:研究成人肱骨髁间骨折治疗及预后情况,以便能够及时有效对其进行合理的治疗。方法:肱骨髁间骨折患者28例,男22例,女6例;年龄21~57岁,平均41.4岁。按Muller分型,C1型8例,C2型12例,C3型8例。所有病例采用侧卧位,肘关节后正中略向内侧弧形切口。应用塑形的Y形钢板与螺钉在肱骨髁部后方对骨折进行固定,术后早期功能锻炼。结果:28例均获得随访,随访时间18~62个月,平均35个月。按Aitken与Rorabeck的评分标准:优15例,良10例,一般2例,差1例,优良率89.3%(25/28)。术后早期尺神经麻痹3例,肘关节异位骨化2例,所有患者仅有1例进行了尺神经前移手术。结论:将钢板置于肱骨背侧可以保证成人肱骨髁间骨折牢固的固定而无须对尺神经与肌肉进行广泛的剥离与牵拉,从而可降低骨折并发症发生率。 相似文献
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经尺骨鹰嘴截骨双钢板内固定治疗肱骨髁间严重粉碎性骨折 总被引:6,自引:3,他引:3
目的:探讨经尺骨鹰嘴截骨双钢板内固定治疗肱骨髁间严重粉碎性骨折的手术方法及疗效。方法:采用经尺骨鹰嘴截骨双钢板内固定治疗肱骨髁间严重粉碎性骨折30例,男19例,女11例;年龄21-62岁,平均42.3岁。按AO/ASIF分类:C2型17例,C3型13例。21例内外侧均采用重建钢板,9例外侧采用重建钢板,内侧采用1/3管形钢板。结果:术后随访6个月-3年,平均1.5年。骨折愈合时间3~6个月,平均4个月。无骨不连、骨化性肌炎、迟发性尺神经受压、内固定失效等并发症。按Aitken—Rorabeck标准评分系统对其肘关节功能评定,优16例,良10例,可2例,差2例。结论:手术解剖复位重建肘关节稳定,术后早期功能锻练,是肘关节功能恢复的重要因素,经尺骨鹰嘴截骨是治疗肱骨髁间严重粉碎性骨折较好入路。 相似文献
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Park HJ Urabe K Naruse K Aikawa J Fujita M Itoman M 《Archives of orthopaedic and trauma surgery》2007,127(9):753-757
Introduction Patients who undergo surgical repair of intercondylar eminence fracture may have postoperative problems despite good reduction.
We used arthroscopy to evaluate the outcomes after surgery to repair intercondylar eminence fractures.
Materials and methods Ten patients (8 men and 2 women; average age at the time of surgery 27.9 ± 10.0 years, range from 14 to 50 years) with fracture
of the tibial intercondylar eminence underwent an arthroscopic reduction and internal fixation with non-absorbable sutures.
Preoperative radiological examination showed that there were one Meyer’s type-II, eight type-IIIA and one type-IIIB fractures.
Clinical symptoms and physical findings for all the patients were evaluated 1 year postoperatively. Radiographic assessment
and the Lysholm rating scale were also utilized. Second-look arthroscopy was performed after 1 year when removing the implant.
Arthroscopy was used to assess the appearance of the surface of the anterior cruciate ligament (ACL), check for the existence
of cyclops and look for interposition of tissue in the lateral and medial joint spaces.
Results One year after the surgery, all ten patients achieved bony union and had negative Lachman and anterior drawer tests. The average
Lysholm knee score was 94.5 ± 7.2 points (range 100–75 points). Arthroscopy showed an irregular surface on the ACL in two
of the ten patients, cyclops in two patients, interposition in the lateral joint space in two patients and interposition in
the medial joint space in one patient. In the two cases seen with an irregular surface, the ACL was covered with droopy fibrous
tissue, but the substance of the ACL was intact. The two patients who had cyclops showed loss of knee extension (5°∼10°),
which was regained by subsequent resection of the cyclops. One patient who had an interposition into the lateral joint space
complained of catching, which was released by resection of the interposing tissue.
Conclusion Arthroscopic refixation of the intercondylar eminence fracture provided bony union and a good clinical outcome. Cyclops syndrome
is one of the causes of loss of knee extension, and soft tissue in the medial or lateral compartment is one of the causes
of catching of knee after surgical repair of intercondylar eminence fracture. Cyclops syndrome, which may occur following
ACL reconstruction, is one of the causes of loss of knee extension after surgical repair of intercondylar eminence fracture.
In patients who have knee complaints, such as catching and loss of knee extension, a second-look arthroscopy is useful for
identifying and correcting the problem. 相似文献
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目的 介绍内外侧新型解剖型接骨板治疗肱骨髁间骨折的手术方法和疗效.方法 自2007年3月至2009年9月手术治疗肱骨髁间骨折35例,男27例,女8例;年龄21~87岁,平均46.2岁;左侧21例,右侧14例.骨折按照AO分型:C1型19例,C2型11例,C3型5例.经肱三头肌两侧入路或尺骨鹰嘴"V"形截骨2路,采用肱骨远端解剖接骨板治疗25例,采用肱骨远端解剖锁定接骨板治疗10例,术后早期积极进行功能锻炼.结果 所有患者术后获得6~24个月(平均14个月)随访,均获骨性愈合,术后未发生感染、内固定松动、异位骨化等并发症.肘关节平均屈伸81°(9~131°),屈曲110°(66~135°),伸直22°(0~75°).Mayo肘关节功能评分平均92分(62~100分),其中优20例,良10例,可4例,差1例,优良率为85.7%.疗效差的1例为C3型骨折合并颅脑外伤,术后未能及早行功能锻炼,造成肘关节僵硬.结论 采用内外侧新型解剖型接骨板治疗肱骨髁间骨折能获得坚强固定,有利于早期肘关节功能锻炼从而获得优良治疗效果. 相似文献
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目的:分析手术复位钢针张力带固定和内外侧双钢板固定治疗肱骨髁间骨折的临床疗效。方法:自1999年1月-2004年2月,手术治疗肱骨髁间骨折48例,按Riseborough分型:Ⅱ型6例,Ⅲ型13例,Ⅳ型29例。手术入路采用经肱三头肌两侧入路28例,尺骨鹰嘴截骨入路20例;内固定方法包括钢针张力带固定23例,内外侧双钢板固定25例。术后早期行功能锻炼。结果:本组48例均获随访,时间12~48个月,平均31个月,用改良Cassebaum评分系统评定肘关节功能,优21例,良18例,可6例,差3例,优良率为81·3%。术后3例关节间隙轻度狭窄和边缘骨赘形成,异位骨化2例,无伤口感染和骨不连,4例尺神经损伤均完全恢复,无一例发生迟发性尺神经炎。结论:经肱三头肌两侧入路和尺骨鹰嘴截骨入路显露肱骨髁间骨折,显露充分,钢针张力带和内外侧双钢板能提供有效固定,合理地运用手术入路和内固定方式,早期行功能锻炼,可取得满意的临床疗效。 相似文献