垂直双钢板内固定术治疗成人肱骨远端C型骨折临床效果分析

目的 探讨垂直双钢板内固定术治疗成人肱骨远端C型骨折的临床效果.方法 回顾性分析2018-01—2019-11间周口豫东医院骨二科行双钢板内固定术治疗的60例成人肱骨远端C型骨折患者的临床资料.按照双钢板固定方式分为垂直组和平行组,各30例.比较2组患者的基线资料和手术时间、术中出血量、住院时间.术后随访6～8个月,统...     

平行与垂直双钢板内固定治疗AO-C型肱骨远端骨折的疗效比较

目的比较平行双钢板及垂直双钢板内固定治疗AO-C型肱骨远端骨折的临床疗效。方法回顾性分析自2011-03—2016-01诊治的32例AO-C型肱骨远端骨折,采用平行双钢板内固定治疗17例(平行组),采用垂直双钢板内固定治疗15例(垂直组)。比较2组术后6个月VAS评分,末次随时肘关节活动屈伸范围、前臂旋转范围及肘关节功能Mayo评分,术后并发症发生情况。结果 32例均获得随访6~12个月,平均10.5个月。平行组1例出现尺神经损伤,予以甲钴胺片营养神经治疗4个月后神经症状恢复;垂直组1例出现轻度异位骨化,患肘屈伸约92°,旋转102°,活动明显受限;平行组、垂直组各2例出现肘关节活动明显受限,需二期行肘关节松解术。2组并发症比较差异无统计学意义(P0.05)。平行组术后6个月VAS评分为(0.59±0.71)分,垂直组为(0.60±0.63)分,2组差异无统计学意义(P0.05)。2组患侧肘关节屈伸活动度、前臂旋转活动度及肘关节功能Mayo评分比较差异均无统计学意义(P0.05)。结论垂直双钢板或平行双钢板内固定治疗AO-C型肱骨远端骨折均可取得良好疗效,应根据骨折的形态、软组织损伤程度、患者一般情况选择适当的内固定方式。     

垂直双钢板与平行双钢板治疗C型肱骨远端骨折的疗效比较

目的：比较垂直双钢板和平行双钢板两种内固定方式治疗C型肱骨远端骨折的临床疗效。方法对25例C型肱骨远端骨折患者进行回顾性研究,其中垂直组14例,平行组11例,比较两组手术时间、术中出血量、并发症及肘关节功能。结果垂直组手术时间更短、术中出血量更少（P＜0.05）;两组并发症发生率、肘关节活动范围、Myao肘关节评分无显著性差异（P＞0.05）。结论垂直双钢板与平行双钢板治疗C型肱骨远端骨折均能提供较好的临床疗效,两者术后肘关节功能及并发症没有差异。     

解剖型钢板治疗肱骨远端骨折16例

肱骨远端骨折是复杂的关节内骨折,过去多以非手术治疗为主,很难达到令人满意的解剖复位,并可能造成更严重的并发症[1].目前,多数学者认为手术治疗可取得较好疗效.自2003年10月～2005年6月,笔者采用Zimmer肱骨远端解剖型钢板内固定治疗肱骨远端骨折16例,取得较好疗效,现报告如下.     

双钢板内固定治疗肱骨远端骨折疗效观察

目的探讨双重建钢板内固定治疗成人肱骨远端骨折的临床效果。方法回顾性分析2010-10—2013-01间应用双钢板内固定治疗肱骨远端骨折22例的临床资料。结果患者均成功实施手术,术后切口均愈合良好。骨折平均愈合时间3.48个月。患者获随访10~18个月,关节活动度根据Cassebaum评分标准评价优良率90.91%(20/22)。结论双钢板内固定治疗肱骨远端粉碎性骨折,固定牢靠、功能恢复优良率高、并发症少。     

双钢板内固定治疗成人肱骨远端骨折

目的:探讨双钢板内固定治疗成人肱骨远端骨折的治疗效果.方法:回顾及分析我院1988年2月～2004年1月应用双钢板内固定治疗肱骨远端骨折17例,骨折按AO/ASIF分型,A 2型3例,A 3型5例,C1型4例,C 2型5例.结果:随访时间10-18个月,平均11个月.按Aitken和Rorabeek标准进行功能评定,结果显示:优12例,良3例,可2例,差0例,优良率88.2％.结论:双钢板内固定治疗肱骨远端粉碎性骨折有适应症广及固定牢靠的优点,疗效满意.     

双钢板内固定治疗肱骨远端C型骨折

肱骨远端C型骨折属关节内骨折,传统的非手术治疗或有限的内固定手术治疗既不能恢复关节解剖形态和关节面平整,又因外固定时间较长,不利于关节功能的恢复,引起不同程度的肘关节功能障碍、骨不连或畸形愈合等并发症[1,2].     

切开复位双钢板内固定治疗肱骨远端C型骨折

目的 探讨双钢板内固定术治疗肱骨远端C型骨折的疗效.方法 手术治疗22例肱骨远端C型骨折,采用尺骨鹰嘴截骨人路,应用双钢板固定肱骨远端内外侧柱,术后早期肘部功能锻炼.结果 随访3～24个月,骨折愈合时间3.5～6.3个月.肘关节功能按Cassebaum评定标准:优14例,良4例,可3例,差1例.结论 双钢板内固定可对肱骨远端C型骨折行坚强内固定,可早期功能锻炼,是一种较为理想治疗方法.     

Y型钢板及双锁定钢板治疗C型肱骨远端骨折疗效研究

[目的]探讨经尺骨鹰嘴截骨入路结合Y型钢板及双锁定钢板治疗C型肱骨远端骨折的疗效比较。[方法]2010年7月²013年8月,用Y型钢板及双锁定钢板采用尺骨鹰嘴截骨入路治疗C型肱骨远端骨折患者52例,每组26人,术后采用Mayo肘关节评分系统评定肘关节功能,结果行统计学对比。[结果]所有患者随访1.52013年8月,用Y型钢板及双锁定钢板采用尺骨鹰嘴截骨入路治疗C型肱骨远端骨折患者52例,每组26人,术后采用Mayo肘关节评分系统评定肘关节功能,结果行统计学对比。[结果]所有患者随访1.5².5年,平均2年。骨折愈合时间32.5年,平均2年。骨折愈合时间3⁷个月,平均4.8个月。骨折(包括鹰嘴截骨)全愈合,无内固定松动及断裂,1例出现肘关节骨化性肌炎。疗效评价参照Mayo肘关节评分,双锁定钢板治疗组优良率显著高于Y型钢板组,结果对比差异有统计学意义。[结论]尺骨鹰嘴截骨入路双钢板治疗肱骨髁间骨折患者的预后佳,并发症少,结合中医中药治疗,值得临床推广。     

双头加压螺钉及双钢板三角固定治疗肱骨远端C型骨折

目的探讨双头加压螺钉及双钢板三角固定治疗肱骨远端C型骨折的临床疗效。方法回顾性分析自2014-01—2020-06采用双头加压螺钉及双钢板三角固定治疗的25例肱骨远端C型骨折,记录骨折愈合情况与骨折愈合时间,末次随访时采用Mayo肘关节功能评分及HSS肘关节功能评分评价疗效。结果 25例均顺利完成手术并获得完整随访,随访时间6~24个月,平均12.5个月。切口均一期愈合,拆线时间为术后12~14 d,平均12.1 d。骨折均达到骨性愈合,骨折愈合时间3~6个月,平均3.5个月。3例术前存在尺神经损伤症状者,术后症状逐渐好转。末次随访时Mayo肘关节功能评分65~100分,平均90.2分,按Mayo肘关节功能评分评价疗效:优16例,良7例,可2例;HSS肘关节功能评分71~100分,平均91.2分,按HSS肘关节功能评分评价疗效:优16例,良6例,可3例。结论双头加压螺钉及双钢板三角固定治疗肱骨远端C型骨折可以获得解剖复位与坚强的内固定,允许患者早期进行功能锻炼,临床疗效良好。     

Stabilisation of articular fractures of the distal humerus: Early experience with a novel perpendicular plate system

Introduction

The treatment of fractures of the distal humerus is difficult and involves the risk of bad functional results, particularly with articular fractures or impaired bone quality. Anatomical reconstruction and stable fixation allowing early mobilisation of the elbow are the basic prerequisites for good clinical outcomes. The aim of our study was to evaluate whether the Distal Humerus Plate (DHP, Synthes), a novel, perpendicular, fixed-angle plate system, fulfils the requirements for this treatment goal.

Methods

From 2004 to 2007, 46 consecutive patients (19 men and 21 women; mean age of 60.5 years) underwent open reduction and internal fixation with the new DHP system. Six patients were lost to follow up. The remaining 40 patients were followed up for 11 months (range 4-24 months). Follow up involved assessment of functional outcome using the Mayo Elbow Performance Score (MEPS) and Liverpool Elbow Score (LES), reduction results and complication rates. Subgroup analyses involved comparisons of younger (<60 years) to elderly (≥60 years) patients and type C3 injuries versus other fracture patterns.

Results

Only six cases received primary internal fixation, whilst 31 patients were temporarily stabilised by either external fixation or cast before ORIF could be performed. Three patients were treated for implant failure (systems other than DHP) after surgery in other hospitals.The mean time from injury to internal fixation was 7 days. Open fractures were present in 10 cases. Olecranon osteotomy was required for reduction in 35 cases. Mean operation time was 215 min.‘Good’ or ‘excellent’ results were observed in 29/40 patients. Median MEPS and LES were 84 and 8.1 points, respectively. Mean ROM was 100°. We found no significant differences in the subgroup analyses; however, there was a tendency towards better functional results in younger patients and injuries without comminution of the articular surface. Complications comprised two superficial wound infections, two cases of heterotopic ossification, one case of delayed union and five cases of transient ulnar neuropathy. Implant failure was observed twice in one patient.

Conclusion

Open reduction and internal fixation with the DHP system provides reliable, stable fixation allowing early functional mobilisation of the elbow joint, even in complex fractures and impaired bone quality, resulting in good outcomes for the majority of patients. The complication rate reported here is comparable to that of other implants, but the low number of implant failures is promising and warrants further investigation.     

Surgical treatment of acute displaced fractures of adult distal humerus with reconstruction plate

We evaluated the results of the use of AO reconstruction plates in the open reduction and internal fixation of acute displaced fractures of the adult distal humerus. This was a retrospective study of such patients where the main surgical strategy was open reduction and internal fixation with AO reconstruction plates. From 1992 to 1998, 40 patients were included. Average follow-up was 98 (60-127) months. All the fractures united with the union time of 11.7 (9-16) weeks. Early post-operative complications developed in four patients (10%), including wound infection in two (5%) and iatrogenic ulnar neuropathy in another two (5%). At follow-up, 24 (60%) patients developed grade 1 osteoarthritis and eight (20%) developed grade 2 osteoarthritis. Thirty-five patients (87.5%) got good to excellent functional results and 35 cases (87.5%) were satisfied with their surgical results. In conclusion, open reduction and internal fixation with AO reconstruction plate is very useful and effective in the treatment of displaced fractures of the adult distal humerus.     

内外侧双钢板治疗肱骨远端C型骨折的疗效分析

目的探讨内外侧双钢板治疗肱骨远端C型骨折的疗效。方法 2002年6月-2009年1月,收治肱骨远端关节内骨折32例。男19例,女13例;年龄19～70岁,平均43.3岁。致伤原因:摔伤7例,交通事故伤15例,高处坠落伤5例,重物击伤4例,机器伤1例。开放骨折1例,闭合骨折31例。骨折按国际内固定研究协会(AO/ASIF)分型:C1型9例,C2型16例,C3型7例。合并尺神经损伤5例。受伤至手术时间为8 h～7 d,平均3.3 d。8例采用后正中切口,24例采用内外侧双切口入路;均采用内外侧双钢板固定骨折。结果术后患者切口均Ⅰ期愈合。32例均获随访,随访时间11～24个月,平均14个月。X线片示骨折均愈合,愈合时间3～6个月,平均3.8个月。肘关节功能按Aitken等的功能评定标准,获优22例,良6例,可3例,差1例,优良率87.5%。术前合并尺神经损伤者,4例于6个月内完全恢复;1例1年后仍遗留部分症状。结论内外侧双钢板能有效治疗肱骨远端C型骨折。     

Locking plate versus external fixation for type C distal radius fractures: A meta-analysis of randomized controlled trials

Purpose

Distal radial fracture is one of the most common fractures. Up to now, locking plates (LP) and external fixation (EF) are two conventional surgical approaches to type C radius fracture. Which method is superior has not yet reached a consensus. We try to assess the clinical effectiveness of the two interventions by this meta-analysis.

切开复位解剖型钢板内固定治疗肱骨远端骨折

[目的]探讨采用切开复位解剖型钢板（“Y”形）内固定治疗肱骨远端骨折的临床疗效。[方法]2001年2月-2006年4月采用切开复位解剖型钢板（“Y”形）内固定治疗肱骨远端骨折共22例，采用尺骨鹰嘴截骨方法显露肱骨远端及关节面骨折者11例，采用肱三头肌舌形瓣方法显露骨折者11例。术后常规中药熏洗、CPM机训练、手法等综合治疗。[结果]22例患者随访时间均超过1a，平均28个月（13—32个月），骨折全部愈合，平均愈合时间为5．7个月（4～10个月），根据Mayo肘关节功能评估指数，结果：优9例（40．9％），良7例（31．81％）。[结论]切开复位解剖型钢板（“Y”形）内固定治疗肱骨远端骨折，固定可靠，为术后早期进行功能锻炼创造了条件；术后早期开始个体化患肢功能锻炼，结合中药熏洗、CPM训练、手法等方法可获得满意疗效。     

Single locking compression plate fixation of extra-articular distal humeral fractures

BackgroundEarlier literature on fixation of distal third humeral fractures describes the use of elaborate modification of existing implants, custom-made implants and dual plating. These modifications have the disadvantages of limitations of hardware availability and cost as well as longer surgical exposure to accommodate the plates. The aim of this study was to assess the effectiveness of osteosynthesis of extra-articular diaphyseal fractures of the distal third of the humerus using a single 4.5-mm locking compression plate (LCP) with two-screw purchase in the distal fragment.ResultsFractures united in all 22 patients with minimal complications. The mean time to union of fracture was 13 weeks. The Mayo elbow score and the DASH scores were in the excellent and good category in all patients at final follow-up.ConclusionsOur study showed that it is possible to obtain excellent outcomes in distal third fractures using only a single 4.5-mm LCP with two-screw (4-cortices) purchase in the distal fragment. The disadvantages inherent in the previous methods can be avoided with the use of the present technique. This technique obviates the need for the use of customized distal humeral implants and modified implants in most patients.

Level of evidence

Level IV.     

Intrafocal pin plate fixation of distal ulna fractures associated with distal radius fractures

Subcapital ulnar fractures in association with distal radius fractures in elderly patients increase instability and pose a treatment challenge. Fixation of the ulnar fracture with traditional implants is difficult due to the subcutaneous location, comminution, and osteoporosis. We describe an intrafocal pin plate that provides fixation by a locking plate on the distal ulna and intramedullary fixation within the shaft. The low profile and percutaneous technique make this device a useful alternative for treatment of subcapital ulna fractures in the elderly.     

Plate selection for fixation of extra-articular distal humerus fractures: A biomechanical comparison of three different implants

Operative fixation of extra-articular distal humerus using a single posterolateral column plate has been described but the biomechanical properties or limits of this technique is undefined. The purpose of this study was to evaluate the mechanical properties of distal humerus fracture fixation using three standard fixation constructs.Two equal groups were created from forty sawbones humeri. Osteotomies were created at 80 mm or 50 mm from the tip of the trochlea. In the proximal osteotomy group, sawbones were fixed with an 8-hole 3.5 mm LCP or with a 6-hole posterolateral plate. In the distal group, sawbones were fixed with 9-hole medial and lateral 3.5 mm distal humerus plates and ten sawbones were fixed with a 6-hole posterolateral plate. Biomechanical testing was performed using a servohydraulic testing machine. Testing in extension as well as internal and external rotation was performed. Destructive testing was also performed with failure being defined as hardware pullout, sawbone failure or cortical contact at the osteotomy.In the proximal osteotomy group, the average bending stiffness and torsional stiffness was significantly greater with the posterolateral plate than with the 3.5 mm LCP. In the distal osteotomy group, the average bending stiffness and torsional stiffness was significantly greater with the posterolateral plate than the 3.5 mm LCP. In extension testing, the yield strength was significantly greater with the posterolateral plate in the proximal osteotomy specimens, and the dual plating construct in the distal osteotomy specimens. The yield strength of specimens in axial torsion was significantly greater with the posterolateral plate in the proximal osteotomy specimens, and the dual plating construct in the distal osteotomy specimens.Limited biomechanical data to support the use of a pre-contoured posterolateral distal humerus LCP for fixation of extra-articular distal humerus exists. We have found that this implant provided significantly greater bending stiffness, torsional stiffness, and yield strength than a single 3.5 mm LCP plate for osteotomies created 80 mm from the trochlea. At the more distal osteotomy, dual plating was biomechanically superior. Our results suggest that single posterolateral column fixation of extra-articular humerus fractures is appropriate for more proximal fractures but that dual plate fixation is superior for more distal fractures.     

肱骨近端锁定钢板治疗肱骨外科颈骨折

目的探讨锁定钢板内固定治疗中老年肱骨外科颈骨折的临床疗效。方法应用肱骨近端锁定钢板内固定治疗中老年肱骨外科颈骨折患者158例,对肩关节功能进行评价。结果患者均获随访,时间3～36个月,骨折愈合时间8～16周。根据Neer肩关节功能评定标准评定疗效：优38例,良92例,可24例,差4例。4例出现肱骨头坏死,但肩关节活动度尚好。优良率达82.28%。结论肱骨近端锁定钢板内固定治疗中老年肱骨外科颈骨折创伤小,固定可靠,临床疗效满意。