中国修复重建外科杂志

中国修复重建外科杂志

不显露尺神经肘关节内侧入路解剖型锁定加压钢板内固定治疗肱骨远端骨折

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目的探讨采用不显露尺神经肘关节内侧切口切开复位解剖型锁定加压钢板(locking compression plate,LCP)内固定治疗肱骨远端骨折的可行性及疗效。方法2014 年 1 月—2017 年 6 月收治 14 例肱骨远端骨折患者,其中男 5 例,女 9 例;年龄 18~85 岁,平均 65.5 岁。致伤原因:摔伤 12 例,交通事故伤 2 例;均为闭合性骨折。骨折按国际内固定研究协会(AO/ASIF)分型:A2 型 3 例,A3 型 2 例,B2 型 4 例,C1 型 2 例,C2 型 2 例,C3 型 1 例;均不伴尺神经损伤。受伤至手术时间为 4~15 d,平均 7 d。B2 型骨折采用不显露尺神经肘内侧入路解剖型 LCP 内固定,余均采用不显露尺神经内侧切口+常规外侧入路双侧解剖型 LCP 内固定。结果手术时间 50~140 min,平均 80 min;术中出血量 20~200 mL,平均 70 mL。术中均无血管、神经损伤,术后切口均Ⅰ期愈合,无切口感染等发生。14 例均获随访,随访时间 9~24 个月,平均 13 个月。X 线片示骨折均于 4 个月内愈合,无骨不连、骨髓炎等并发症发生;随访过程中均无尺神经损伤表现,无肘内外翻畸形及骨化性肌炎发生。末次随访时按 Mayo 肘关节功能评分系统(MEPS)评定肘关节功能,获优 8 例、良 4 例、可 1 例、差 1 例(为 C3 型骨折),优良率 85.7%。结论不显露尺神经行肘关节内侧切口可满意复位骨折,不易发生尺神经损伤,具有手术时间短、创伤小、出血少、疗效可靠等优点。

ObjectiveTo investigate the feasibility and effectiveness of unexposed ulnar nerve medial elbow incision, open reduction and internal fixation of anatomical locking compression plate (LCP) for distal humerus fractures.MethodsFourteen patients with distal humerus fracture were treated between January 2014 and June 2017. There were 5 males and 9 females, aged 18-85 years (mean, 65.5 years). The causes of injury included falling from height in 12 cases and traffic accident in 2 cases, all were closed fractures. Fractures were classified according to the AO/Association for the Study of Internal Fixation (AO/ASIF): 3 cases of type A2, 2 cases of type A3, 4 cases of type B2, 2 cases of type C1, 2 cases of type C2, and 1 case of type C3; without ulnar nerve damage. The time from injury to operation was 4-15 days, with an average of 7 days. The type B2 fractures were treated with unexposed ulnar nerve elbow medial incision and anatomic LCP internal fixation, the rest patients were all treated with unexposed ulnar nerve medial plus conventional lateral approach and bilateral LCP internal fixation.ResultsThe operation time was 50-140 minutes (mean, 80 minutes), and the intraoperative blood loss was 20-200 mL (mean, 70 mL). There was no blood vessels or nerve damage during operation. All incisions healed by first intension, and no incision infection occurred. All the 14 cases were followed up 9-24 months (mean, 13 months). X-ray films showed that all fractures healed within 4 months without complications such as nonunion and osteomyelitis. No ulnar nerve injury, cubitus varus deformity, and ossifying myositis occurred during follow-up. At last follow-up, the elbow function was assessed by Mayo Elbow Performance score (MEPS), the results were excellent in 8 cases, good in 4 cases, fair in 1 case, and poor in 1 case (type C3 fracture), with the excellent and good rate of 85.7%.ConclusionThe unexposed ulnar nerve medial elbow incision can be used effectively to reduct the fracture, and it is not prone to ulnar nerve injury. Combined with the lateral approach to treat the distal humerus fracture, which has the advantages of short operation time, few trauma, little bleeding, and reliable effectiveness.

关键词: 尺神经; 肱骨远端骨折; 锁定加压钢板; 内固定

Key words: Ulnar nerve; distal humerus fracture; locking compression plate; internal fixation

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