铰链式外固定支架和石膏外固定治疗急性复杂性肘关节不稳的临床疗效比较

目的探讨应用铰链式外固定支架结合有限内固定和切开复位内固定结合石膏外固定治疗急性复杂性肘关节不稳的临床疗效比较。方法2004年1月至2006年6月，80例不稳定性肘关节骨折脱位患者进行手术治疗并获得随访，其中支架组38例，男24例，女14例；年龄17～60岁，平均32．8岁；左侧13例，右侧24例，双侧1例。石膏组42例，男20例，女22例；年龄20～65岁，平均34．6岁；左侧18例，右侧23例，双侧1例。以肘关节功能评价法（JOA）评分标准进行肘关节功能评定。结果80例获得随访，其中支架组38例，石膏组42例；随访时间12～18个月，平均15．6个月。外固定支架使用6～8周，平均7．5周。骨折愈合时间石膏组6～8周，平均7．5周；支架组7～9周，平均8周。术后石膏组JOA功能评分为（15．51±1．50）分，活动度评分为（13．40±7．79）分，支架组JOA功能评分为（18．51±1．40）分，活动度评分为（18．54±8．62）分，两组在功能和活动度方面比较差异均有统计学意义（P〈0．01）；而在疼痛、关节动摇性和畸形方面的组间评分无显著性差异（P〉0．05）；支架组总评分为（73．44±10．21）分，石膏组为（81．63±10．75）分，两组比较差异有统计学意义（P〈0．01）。结论铰链式外固定支架能增加肘关节侧方的稳定性，有利于维持骨折脱位的复位，保证早期安全的功能锻炼，预防关节僵硬，减少异位骨化的发生。与其他治疗方式相比，铰链式外固定支架在急性复杂性肘关节不稳的治疗中对早期肘关节的功能恢复更具优越性。

Comparison of the effectiveness between hinged external fixator and castfixation in treating acute complex instability of elbow

Objective To compare hinged external fixator combining with internal fixation and cast fixation after routine surgery in treatment of acute complex instability of elbow. Methods From January 2004 to June 2006, 103 cases of unstable elbow fracture dislocation were treated respectively by unilateral hinged external fixator and cast fixation, and 80 of them were followed up. There were 44 males and 36 females with the average age of 33.7 years （ 17 - 65 years）. They were divid- ed into fixator group （n =38） and cast group （n =42） The 80 elbow fracture dislocation involved 31 on left side, 47 on right side and 2 bilaterally. All the 80 cases were evaluated with JOA assessment score. Results The average follow - up time was 15. 6 months （12- 18 months）. The mean time of fixation with fixator was 7.5 weeks （6 -8 weeks）. The mean time of fracture healing was 7.5 weeks in cast group and 8 weeks in fixator group. Both function and arc of motion in cast group and fixator group showed significant difference （ 15. 51 ± 1.50 vs 18.51± 1.40, P 〈 0. 01 ; 13.40 ±7.79 vs 18. 54 ±8.62, P 〈0. 01 ）, While the pain, articular instability and deformity showed no statistical difference. The total assessment score between 2 groups indicated marked difference （73.44± 10. 21 vs 81.63 ± 10. 75, P 〈 0. 01 ）. Conclusion Hinged external fixator can enhance lateral stability of elbows, benefit the reduction of fracture dislocation, guarantee early safe functional exercise, prevent from elbow stiffness, and reduce heterotopic ossification. In treating acute complex instability of elbow, the hinged external fixator is superior to other therapy with respect of improving the function of elbow joint.