内固定结合铰链式外固定支架治疗复杂肘关节骨折

目的探讨铰链式外固定支架结合内固定治疗复杂肘关节骨折的疗效。方法回顾性分析2010年5月~2015年3月收治的复杂肘关节骨折患者46例,26例行内固定结合外固定支架治疗(外固定支架组),其中肘关节"恐怖三联征"12例,后孟氏骨折6例,经鹰嘴骨折脱位8例;20例行内固定结合可调节支具外固定治疗(可调节支具组),其中肘关节"恐怖三联征"10例,后孟氏骨折5例,经鹰嘴骨折脱位5例。所有患者均行切开复位内固定术,外固定支架组结合铰链式外固定支架固定,可调节支具组术后采用可调节支具外固定。末次随访时采用Mayo肘关节功能评分(MEPS)评定肘关节功能。结果所有患者获得术后10~24个月(平均16.8个月)随访,所有患者骨折均获骨性愈合,外固定支架组愈合时间为(12.6±2.4)周,可调节支具组愈合时间(13.8±3.6)周,差异无统计学意义(P0.05)。外固定支架组肘关节平均屈伸范围为129.98°±12.59°,前臂平均旋转范围为142.15°±15.35°,MEPS评分平均为91分(58~96分),优21例,良2例,可2例,差1例,优良率为88.5%。可调节支具组肘关节平均屈伸范围为106.98°±10.36°,前臂平均旋转范围为121.32°±17.67°,MEPS评分平均为82分(55~92分),优10例,良4例,可2例,差4例,优良率为70.0%,差异有统计学意义(P0.05)。结论内固定结合铰链式外固定架可以使肘关节获得更好的功能恢复。

Hinged external fixator combined with internal fixation in the treatment of complex elbow fractures

Objective To explore the effect of hinged external fixator combined with internal fixation in the treatment of complex elbow fractures.Methods From May 2010 to Mar.2015,46 patients with complex elbow fractures were treated and analyzed retrospectively.Among them,26 patients underwent external fixation combined with external fixator (external fixator group),including terrible triad of the elbow in 12 cases,anti Monteggia fracture in 6 cases,and olecranon fracture and dislocation in 8 cases;20 patients were treated with internal fixation combined with adjustable protector (adjustable protector group),including terrible triad of the elbow in 10 cases,anti Monteggia fracture in 5 cases,and olecranon fracture and dislocation in 5 cases.All patients underwent open reduction and internal fixation.The external fixator group was fixed with the hinged external fixator,and the adjustable protector group was treated with adjustable protector after internal fixation.The elbow function was evaluated at the last follow-up by Mayo elbow performance score (MEPS).Results All the 46 patients were followed up for 10 to 24 months (average,16.8 months).All the patients obtained bone union.The healing time of the external fixator group was (12.6±2.4) weeks,and the healing time of the adjustable protector group was (13.8±3.6) weeks,without significant difference between the two groups (P>0.05).At the last follow-up,for the external fixator group,the flexion and extension angle of the elbow joint was 129.98°±12.59°,the rotation angle of the forearm was 142.15°±15.35°,and the average MEPS was 91 points (58-96 points).The MEPS results indicated excellent in 21 cases,good in 2 cases,fair in 2 cases,and poor in 1 case,with the excellent and good rate of 88.5%.For the adjustable protector group,the flexion and extension angle was 106.98°±10.36°(56°-112°),the rotation angle was 121.32°±17.67°(64°-127°),and the average MEPS was 82 points (55-92 points).The MEPS results indicated excellent in 10 cases,good in 4 cases,fair in 2 cases,and poor in 4 cases,with the excellent and good rate of 70.0%.All the indicators had significant differences between the two groups(P<0.05).Conclusion The internal fixation combined with hinged external fixation can get better functional recovery for complex elbow fracture.