成人肱骨髁间骨折的治疗

目的:研究成人肱骨髁间骨折治疗及预后情况,以便能够及时有效对其进行合理的治疗。方法:肱骨髁间骨折患者28例,男22例,女6例;年龄21~57岁,平均41.4岁。按Muller分型,C1型8例,C2型12例,C3型8例。所有病例采用侧卧位,肘关节后正中略向内侧弧形切口。应用塑形的Y形钢板与螺钉在肱骨髁部后方对骨折进行固定,术后早期功能锻炼。结果:28例均获得随访,随访时间18~62个月,平均35个月。按Aitken与Rorabeck的评分标准:优15例,良10例,一般2例,差1例,优良率89.3%(25/28)。术后早期尺神经麻痹3例,肘关节异位骨化2例,所有患者仅有1例进行了尺神经前移手术。结论:将钢板置于肱骨背侧可以保证成人肱骨髁间骨折牢固的固定而无须对尺神经与肌肉进行广泛的剥离与牵拉,从而可降低骨折并发症发生率。

Operative treatment of intercondylar fractures of the distal humerus in adults

Objective:To study the therapy and prognosis for intercondylar fracture of the distal humerus in adults in order to gain an effective and reasonabale treatment for those patients in time.Methods:Twenty-eight patients of intercondylar fractures of the distal humerus included 22 male and 6 female with an average age of 41.4 years ranging from 21 to 57 years.According to Muller classification,there were 8 cases of type C1,12 of type C2 and 8 of type C3.All fractures were treated by open reduction and internal fixation of Y-shape plate in the lateral decubitus position with a posterior and medial midline approach to elbow.The early mobilization followed by the operation.Results:All the patients were followed up from 18 to 62 months,the average period was 35 months.According to Aitken and Rorabeck Score,the result was excellent in 15 cases,good in 10,fair in 2 and poor in 1.The excellent and good rate was 89.3%(25/28).The complication of ulnar nerve neuropraxia was occurred in 3 cases and heterotopic bone formation was occurred in 2 cases.Anterior transposition of the ulnar nerve was performed in only one of the patients.Conclusion:For intercondylar fracture of the distal humerus in adults,posterior placement of the plates provides an adequately stable fixation and requires less extensive dissection or retraction of the ulnar nerve,thereby,decreasing the incidence of complications of fracture.