肱骨髁间粉碎性骨折的治疗

目的]探讨肱骨髁间粉碎性骨折的术式选择及疗效。方法]2001年2月-2005年12月治疗肱骨髁间粉碎性骨折患者21例，按AO分型：C1型5例，C2型9例，C3型7例。17例患者行切开复位钢板内固定术，4例行全肘关节置换术。内固定组采用尺骨鹰嘴截骨入路，肱骨小头和肱骨滑车复位后用松质骨螺钉或空心螺钉固定，肱骨干和肱骨远端之间采用AO双钢板或“Y”钢板固定，术后早期功能锻炼；肘关节置换组采用半限制型肘关节假体、骨水泥固定，术后4-7d开始功能锻炼。结果]内固定组17例患者中14例获12-44个月随访，关节置换组4例全部获14，36个月随访，按Cassebaum肘关节功能评分，内固定组优g4例，良：6例，优良率71．4％，关节置换组优：2例，良：2例，优良率100％。结论]肱骨髁间粉碎性骨折采用AO技术，经尺骨鹰嘴截骨入路切开复位，双重建钢板或“Y”钢板内固定，配合早期功能锻炼，大多数患者都能获得良好的疗效。对肱骨远端严重毁损，骨质疏松明显，年龄在50岁以上的患者，可选择全肘关节置换手术，近期疗效满意。

Treatment of intercondylar humeral comminuted fractures

Objective] To evaluate surgical treatment and curative effect of intercondylar humeral comminuted fractures. Method]Twenty-one cases of intercondylar humeral comminuted fractures were collected from February 2001 to December 2005. The fractures were classified to 5 cases of C1,9 cases of C2 and 7 cases of C3 according to the AO classification. Seventeen fractures were internal fixed by open-reduction, and 4 fractures were treated by total elbow replacement. After olecranon osteotomy, capitate eminence and trochlea humerus were reducted and fixed with bone screw,while shaft of humerus and the distal end of humerus were fixed with AO double plate or Y-shaped plate in internal fixed group. Early physiotherapy were started as soon as possible. The elbow replacement group were replaced by semi-restriction elbow prosthesis and fixed with cemente following physiotherapy after 4 to 7 days. Result] forteen of 17 cases were postoperatively followed-up in internal fixed group from 12 to 44 months, and all cases had been visited for 14 to 36 months in elbow replacement group. According to modified Cassebaum scoring system, 71.4% were good in internal fixed group and 100% in elbow replacement group. Condusion] It has good curative effect in intercondylar humeral comminuted fractures with olecranon osteotomy, the AO double plate or Y-shaped plate internal fixation and early physiotherapy. With severe injury of the distal end of humerus, obviously osteoporosis and older than 50 years, the total elbow arthroplasty and replacement are preferred.