肱骨远端关节内骨折手术治疗效果分析

目的分析肱骨远端关节内骨折的手术方法和常见并发症，评价手术治疗效果。方法2003年6月至2008年4月，收治肱骨远端关节内骨折患者43例，男30例，女13例；年龄18～76岁，平均39．3岁。其中AO／OTA分类B型18例，C型25例。分别采用经尺骨鹰嘴截骨入路、肱三头肌旁入路、劈开肱三头肌入路和肱三头肌远端舌形切断入路行肱骨远端关节内骨折切开复位及钢板内固定术，术后患者均未行外固定。术后1．5、3、6、12、24、36个月复查肘关节活动度和功能。结果术后开始主动及被动功能锻炼的时间为2～8d，平均3．6d。43例患者中36例获得随访，随访时间11～69个月，平均28个月。按照Mayo肘关节功能评分标准：优18例，良15例，可3例；优良率为91．2％。关节活动度74°～125°，平均95°。术后2例发生切口浅层感染，1例一过性尺神经损伤，1例复位不良。2例骨折延迟愈合，1例尺骨鹰嘴截骨处延迟愈合。结论肱骨远端关节内骨折的手术治疗效果良好。不同的肘关节后方手术入路方式中，经尺骨鹰嘴截骨入路的疗效评分优于经肱三头肌旁入路、劈开肱三头肌入路和肱三头肌远端舌形切断入路。

Evaluation of surgical treatment for intra-articular fractures of distal humerus

Objective To retrospectively analyze surgical technique in the treatment of intra - articular fractures of distal humerus via different approaches, to observe common complications, and to evaluate the curative effect of the surgery. Methods Between June 2003 and April 2008, 43 cases of intra - articular fractures of distal humerus, including 18 cases of AO/OTA type B and 25 cases of AO/OTA type C, were treated by open reduction and internal fixation via different approaches including olecranon osteotomy, extensor mechanism - sparing paratricipital, triceps splitting, and triceps reflecting. No external fixation was needed after surgery, and passive and active exercise were initiated 2 - 8 d postoperatively with an average of 3.6 d. Patients were followed up 1.5, 3, 6, 12, 24 and 36 months after surgery, and elbow range of motion （ROM） and function were evaluated. Results Of the patients, 36 were available for follow up and 7 lost. Follow up time ranged 11 tO 69 months, with an average of 28 months. According to MEPS evaluation, there were 18 cases graded as excellent, 15 cases good, and 3 cases fair . The rate for excellent and good was 91.2%. ROM of el- bow joint averaged 95° （74°- 125° ）. The overall complication rate was 19. 4% , including two cases of superficial infection, one transient ulnar nerve palsy, one mah＇eduction, two delayed union of fracture and one delayed union of olecranon osteotomy. Conclusion Surgical treatment of intra - articular fractures of distal humeras can achieve good effectiveness. Among different posterior elbow approaches, olecranon osteotomy had better functional evaluation score than extensor mechanism - sparing paratricipital, triceps splitting, and triceps reflecting approaches.