覃松，喻爱喜，潘振宇，祝少博，王凯
摘要：目的 探讨应用平行双钢板内固定技术治疗肱骨远端复杂骨折的临床疗效.方法 2007年8月至2008年10月,应用平行双钢板内固定技术治疗12例肱骨远端复杂骨折患者,男8例,女4例;年龄32～74岁,平均52.3岁;左侧5例,右侧7例.按AO/OTA分型:C1型1例,C2型3例,C3型8例.开放性骨折2例(均为Gustilo-Anderson Ⅰ型),皮肤挫伤3例,多发性损伤8例,合并原发性尺神经损伤2例.受伤至就诊时间为1 h～3 d.开放性骨折及尺神经损伤患者在6 h内行一期于术治疗,其余患者待局部肿胀消退、皮肤出现皱褶后4～7 d内进行手术.按照Mayo肘关节功能评分(MEPS)标准及X线片评估疗效.结果 所有患者均获得3～16个月(平均9.5个月)随访.骨折经摄X线片证实均一期愈合,愈合时间为6～18周,平均11.5周,无一例患者出现内固定松动及骨折移位.末次随访患侧肘关节平均活动范围为112.9°(40°～145°),MEPS评分平均为83.8分(45～100分),疗效评定:优6例,良4例,可1例,差1例,优良率为83.3%.结论 应用平行舣钢板内固定技术治疗肱骨远端复杂骨折可以获得坚强的内固定,有助于早期康复锻炼,临床疗效较好.
Abstract：Objective To study the treatment of complex distal humeral fractures in adults with the parallel-plate technique. Methods From August 2007 to October 2008, 12 patients with complex distal humeral fractures were treated by open reduction and internal fixation using parallel plating. There were 8 males and 4 females, with an average age of 52. 3 years (range, 32 to 74 years). Five fractures occurred on the left extremity and 7 on the right. The fractures resulted from a traffic accident or falling in 11 and other trauma in one. According to AO/OTA classification, one case belonged to C1 type, 3 to C2 type, and 8 to C3 type. Two cases suffered from open fracture (Gustilo scale Ⅰ). Skin contusion occurred in 3 patients, multiple injuries in 8, and primary injury of ulnar never in 2. The function of elbow was assessed according to Mayo elbow performance score (MEPS) and plain X-ray films. Results The 12 patients were followed up for 3 to 16 months (mean, 9. 5 months). The mean fracture healing time was 11.5 weeks (range, 6 to 18 weeks). No nonunion, delayed union, displacement, avascular necrosis, or implant failure was observed. The range of motion of the elbow joint averaged 112.9° (40° to 145°) and the mean MEPS was 83.8 (45 to 100) points at the final follow-up. The clinical outcomes were excellent in 6 cases, good in 4, fair in one and poor in one. The overall excellent to good rate was 83.3%. Conclusion The parallel-plate technique can be used in the treatment of complex distal humeral fractures in adults to obtain stable internal fixation, early postoperative rehabilitation and satisfactory clinical effect.
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