经肱三头肌舌形瓣入路双钢板治疗AO C3型肱骨髁间骨折34例体会

目的探讨经三头肌舌形瓣入路应用肱骨内、外髁解剖钢板治疗AOC3型肱骨髁间骨折的方法和临床疗效。方法 2004年2月～2009年6月采用经三头肌舌形瓣入路结合肱骨内、外髁解剖钢板治疗AOC3型肱骨髁间骨折34例。结果术后32例骨折复位满意,2例复位稍差,无切口感染,32例获得随访,时间6～19个月,平均13.5个月。骨折全部愈合,无内固定松动及断裂,无肘关节疼痛,肘关节活动弧度平均92°（88°～107°）,愈合时间14～24周,平均17周。根据Jupiter方法评价肘关节功能,平均84.5分,优10例,良19例,可4例,差1例,优良率85.29%。结论经三头肌舌形瓣入路显露骨折充分,肱骨内、外髁解剖钢板固定AOC3型肱骨髁间骨折牢固可靠,能有效的防止骨折不愈合,并可满足患者早期进行关节功能锻炼。

The triceps tongue-shaped flap approach double-plate fixation for 34 cases of AO C3 type intercondylar fracture of humerus

Objective The purpose of this study was to determine the outcome of treating complex distal humeral fractures （AO C3） with double-plate fixation through triceps tongue-shaped flap approuch.Methods Thirty-four consecutive complex distal humeral fractures （AO C3） were fixed with two parallel plates （medially and laterally） applied in approximately the sagittal plane through triceps tongue-shaped flap approach.The patients were assessed clinically with use of the Mayo Elbow Performance Score （MEPS） and radiographically.Results 32 cases remained good reduction without infection.32 of 34 cases were followed for 6 to 19 months,an average of 13.5 months.Neither hardware failure nor fracture displacement occurred in any patient.Elbow pain was not occurred.The mean flexion-extension arc was 92° （88°～107°）,and the mean MEPS was 84.5 points.Healing time was 14 to 24 weeks,17 weeks on average.The result was graded as excellent for ten elbows,good for nineteen,fair for four,and poor for one.Excellent rate was 85.29%.Conclusion Stable fixation and a high rate of union of complex distal humeral fractures can be achieved with double-plate fixation through triceps tongue-shaped flap approach.Elbow functional activity can be achieved in patients with early stage.