老年肱骨远端骨折治疗中垂直与平行双钢板的疗效对比

目的：探讨垂直或平行双钢板在治疗老年骨质疏松性肱骨远端骨折中的优劣。方法回顾性地分析2008年9月至2013年1月解放军总医院收治的老年肱骨远端骨折患者39例，平均年龄64（60-81）岁，其中21例患者采用垂直双钢板内固定，18例患者采用平行双钢板内固定。评价手术时间、术中出血量、骨折愈合时间、肘关节活动度，并按Mayo肘关节功能评分（MEPS）评估疗效。结果所有患者术后均获得随访，时间12-25个月，垂直钢板组平均（17.0±1.5）个月，MEPS平均（82.0±5.6）分，优良率81.0%；平行钢板组随访时间平均（15.0±2.0）个月，MEPS平均（83.1±5.5）分，优良率88.9%。手术时间、出血量、骨折愈合时间、功能评分等组间差异均无统计学意义（P＞0.05）。垂直钢板组中有2例骨折延迟愈合，经二次手术植骨后愈合；1例发生异位骨化，轻度影响术后功能。结论两种内固定方式都可提供初期良好的复位与稳定。与垂直双钢板相比，平行钢板内固定在减少老年人肱骨远端骨折并发症方面可能更有优势。

Efficiency of parallel versus perpendicular double plating for distal humerus fracture in the elderly

ObjectiveTo determine the strengths and weaknesses between parallel double plating and perpendicular double plating in the treatment of elderly distal humeral fractures.Methods Clinical data of 39 elderly patients （mean age 64 years, ranging from 60 to 81years） with distal humerus fractures who underwent parallel double plating （n=18） or perpendicular plating （n=21） in Chinese PLA General Hospital from September 2008 and January 2013 were collected and retrospectively analyzed. Their surgical duration, blood loss, fracture healing time, flexion-extension arc, and the total range of flexion and extension were compared between the 2 groups. Mayo Elbow Performance Score （MEPS） was used to determine the elbow functional results.Results All patients were followed up for 12 to 25 months, with a mean duration of （17.0±1.5） months for perpendicular group and of （15.0±2.0） months for parallel group. For the former group, their mean MEPS was （82.0±5.6） points, and the rate of excellent and good results was 81.0%. While, for the latter, the mean MEPS was （83.1±5.5） points, and the rate of excellent and good results was 88.9%. No significant differencewas seen in the surgical duration, blood loss, bone union time and functional results between the 2 groups. There were 2 cases of delay-union （finally healed after secondary operation） and 1 case of heterotopic ossification （mildly affecting postoperative outcomes） in the perpendicular group.Conclusion Although both methods provide sound anatomical reconstruction and stable fixation in the early term for distal humeral fractures in elderly patients, the parallel double plating is superior to perpendicular one in reducing the complications.