平行双接骨板内固定治疗老年肱骨远端粉碎性骨折

目的 探讨平行双接骨板固定技术治疗老年肱骨远端粉碎性骨折的疗效.方法 2007年1月至2008年9月,采用切开复位平行双接骨板内固定治疗老年肱骨远端粉碎性骨折22例,男6例,女16例;年龄60～81岁,平均70.2岁;开放性损伤3例(均为Gustilo Ⅰ型),闭合性损伤19例.骨折按照AO分型:C1型5例,C2型10例,C3型7例.手术采用肘后正中切口,经尺骨鹰嘴"V"形截骨入路(8例)和肱三头肌"舌"形瓣入路(14例)显露肱骨远端关节面,术后3 d开始保护性功能锻炼.结果本组患者获得13～35个月(平均18个月)随访,均获骨性愈合.肘关节平均伸16°(0～50°),屈125°(95°～140°),旋前65°(40°～90°),旋后67°(40°～90°).Mayo肘关节功能评分平均87.2分(55～100分),其中优11例,良8例,可2例,差1例,优良率为86.4%.术后并发症:2例出现暂时性尺神经麻痹,2例发生异位骨化,1例出现骨折愈合延迟并最终导致肘关节僵硬,3例有创伤性关节炎表现,2例发生轻度肘关节内翻畸形.结论 切开复位平行双接骨板内固定治疗老年肱骨远端粉碎性骨折在骨折愈合、早期活动及功能恢复方面取得满意疗效,但应认识到老年肱骨远端粉碎性骨折本身的复杂性对患者术后疗效的影响.

Treatment of AO/OTA type C distal humeral fractures by parallel-plate fixation in the aged

Objective To summarize our experience of treating distal humeral fractures of AO/OTA type C with parallel-plate fixation in the aged. Methods From January 2007 to September 2008, we treated 22 cases of type C distal humeral fractures by parallel-plating. They were 6 males and 16 females, with a mean age of 70. 2 (range, 60 to 81 ) years, including 3 open fractures (Gustilo type Ⅰ) and 19 close fractures. According to AO classification, there were 5 cases of type C1, 10 cases of type C2 and 7 cases of type C3. The posterior midline approach was selected. After the articular surface of the distal humerus was exposed through the olecranon osteotomy or the liguliform flap of triceps brachii muscle, parallel-plate fixation was performed to fix fractures internally. All patients began functional exercise of the elbow joint from 3 days after operation. Results All patients were followed up for a mean of 18 (range, 13 to 35) months. All fractures achieved complete union. The mean degrees of the elbow movement were as follows: extension was 16°(range, 0 to 50°), flexion 125° (range, 95° to 140°), supination 65° (range, 40° to 90°) and pronation 67°(range, 40° to 90°). According to Mayo elbow performance score (MEPS), 11 cases were graded as excellent, 8 as good, 2 as fair and one as poor. 86. 4% of the patients had an excellent or good functional result. Two cases reported transient ulnar nerve paralysis, 2 heterotopic ossification, one delayed union and elbow stiffness,3 slight symptoms of traumatic arthritis, and 2 slight malformation of cubitus varus. Conclusions Parallel-plate fixation is a preferred treatment for AO type C distal humeral fractures in the aged because of satisfactory bone healing, early mobilization and recovery of joint function. However, more attention should be paid to the complexity of the fracture which may influence the therapeutic effects of the operation.