重建钢板固定和尺神经前置治疗肱骨髁间骨折

目的评价AO重建钢板固定及常规尺神经前置治疗肱骨髁间骨折的疗效。方法1996年3月～2001年9月,手术治疗肱骨髁间骨折68例,随访资料完整43例,男28例,女15例;年龄18～65岁,平均41岁。开放性骨折7例,闭合性骨折36例。43例肱骨髁间骨折按AO/ASIF分型:C1型14例,C2型18例,C3型11例。行切开复位AO重建钢板内固定,并常规行尺神经前置。取肘后正中切口,经肱三头肌舌形瓣入路32例,经尺骨鹰嘴截骨入路6例,合并鹰嘴骨折经骨折端进入5例。术后早期行肘关节CPM功能锻炼。结果随访12～37个月,平均17.7个月。术后12～18周,骨折全部愈合。采用Aitken-Rorabeck评分系统进行疗效评定:优33例,良4例,可5例,差1例;优良率为86.1%。6例尺神经损伤均完全恢复,无一例发生迟发性神经麻痹。伤后4周出现异位骨化2例;肘内翻3°1例,但不影响肘关节的功能;切口感染3例。肘关节功能受限2例,其中1例伸屈为43°,另1例为62°。结论肱骨髁间骨折应及早解剖复位,尺神经前置能减少尺神经麻痹的发生,早期进行功能锻炼,有助于肘关节功能的恢复。

The results of humeral intercondylar fracture treated reconstruction plate internal fixation and anterior transposition of ulnar nerve

Objective The retrospective analysis was carried out to evaluate the results of humeral intercondylar fracture treated with AO reconstruction plate internal fixation accompanied by anterior transposition of the ulnar nerve. Methods From March 1996 to September 2001, sixty-eight patients diagnosed as humeral intercondylar fractures were treated in our hospital, forty-three of which were followed up and evaluated. By AO/ASIF classification, there were type C1 in 14 cases, type C2 in 18 cases, and type C3 in 11 cases. There were 18 male and 15 female patients with an average of 41 years ranging from 18 to 65 years. The patients were open fracture in 7 cases and closed fracture in 36 cases, of which were associated with humeral shaft fracture in 4 cases, Colles fracture in 5 cases, Monteggia fracture in 3 cases, olecranon fracture in 5 cases, and ulnar nerve injury in 6 cases. They were treated with open reduction and AO reconstruction plate internal fixation combined with routine anterior transposition of the ulnar nerve followed by early CPM mobilization. Results The mean follow-up of the group was 17.7 months ranging 12 to 37 months with bone union in 12 to 18 weeks. The outcome was evaluated with Aitken-Rorabeck rating system, 33 of which were graded as excellent, 4 cases as good, 5 cases as fair, 1 case as poor, as a result, the elbow function was excellent to good in 86.1%. One case experienced three degrees cubital varus without an influence on function of the elbow. The wound infection occurred in three cases healed following dress change. A heterotopic ossification developed in two cases 4 weeks later after operation. The preoperative ulnar nerve palsy recovered in all 6 cases, and there was no delayed ulnar nerve palsy happened postoperatively. Two elbow joints were restricted during extension to flexion activity by 43 degrees and 62 degrees respectively. Conclusion Intercondylar fractures of the distal humerus should be treated surgically as early as possible. Anatomical reduction, rigid fixation and early CPM exercise are the key prognostic factors, which could improve the elbow function. Otherwise routine anterior transposition of the ulnar nerve may be helpful to reduce the incidence of delayed ulnar nerve palsy.