双钢板治疗成人肱骨远端复杂粉碎骨折疗效分析.DOCVIP

临床医学论文-双钢板治疗成人肱骨远端复杂粉碎骨折疗效分析 【摘要】? [目的]讨论成人肱骨远端复杂粉碎骨折使用双钢板内固定的手术方法及疗效。[方法]回顾分析本院2004年4月-2007年4月应用双钢板内固定治疗成人肱骨远端复杂粉碎性骨折28例，骨折按AO/ASIF分型法分型，均为C型，其中C1型9例，C2型15例，C3型4例。均取肘后正中切口，行切开复位双钢板螺钉内固定治疗。其中经肱三头肌舌形瓣15例，尺骨鹰嘴截骨13例(包括伴同侧鹰嘴骨折1例)。手术先行关节内骨折关节面复位，细克氏针临时固定，使复杂粉碎骨折变为简单的肱骨髁上骨折，然后再行干骺端复位。内固定方式，按骨折情况选用型号大小相吻合的重建钢板固定肱骨远端桡侧柱后方，以塑形良好的1/3管型钢板固定肱骨尺侧柱的内缘，这样就在二个互成90°的平面上分别固定了肱骨髁的内外侧柱。[结果]本组随访8～33个月，平均随访17个月，骨折愈合时间8～16周，23例术后功能恢复良好，有1例骨化性肌炎形成，4例关节间隙狭窄，无骨不愈合及尺神经损伤病例，优良率82.1%。[结论]成人肱骨远端复杂粉碎骨折，结构复杂，手术难度大，切开复位双钢板螺丝钉内固定治疗，固定强度和抗疲劳作用均强于其他固定方式，有利于肘关节的早期活动和防止粘连，能有效地恢复肘关节功能，是一种较理想的治疗方法。 【关键词】? 肱骨远端; 骨折; 内固定 Efficiency evaluation of Ytype reconstruction plate internal fixation treating the distal humeral comminuted and complicated fracture∥TAI Huiping,GUO Shifang,XUE Wen.Department of Orthopeadics,the People′s Hospital of Gansu,Lanzhou 730000,China 　　Abstract：[Objective]To evaluate the two plates internal fixation treating the distal humeral comminuted and complicated fracture.[Method]Twentyeight patient with comminuted distal humeral fracture were treated with the doubleplate internal fixation from April 2004 to April 2007.According to AO/ASIF classification method,all fractures were C types.There were 9 C1 types,15 C2 types,4 C3 types.All cases were taken from the middle of posterior elbow incision.The patients were treated with the open reduction and double plate internal fixation.Fifteen cases were done through the triceps tongueshaped flap,13 cases were olecranon osteotomy (including one case with olecranon fractures with ipsilateral).Surgical steps included:the articular surface reduction of intraarticular fractures,small temporary Kirschner wire fixation,making the complete fractures into simple comminuted fractures of humerl condylar fractures,then resetting metaphysis.Internal fixation method used the restruction plate according to the size of fracture.The restruction plate was fixed in the back of the distal humeral radial column.Onethird of a goodshaped tubular plate was us