CAJ | 학술논문

目的：探讨经后入路应用平行或垂直双钢板固定治疗成人C型肱骨远端骨折的方法和临床疗效。方法2005年7月～2012年11月采用后入路双钢板固定治疗成人C型肱骨远端骨折54例，其中经肱三头肌双侧入路18例，经尺骨鹰嘴截骨入路36例；双钢板平行固定14例，垂直固定40例。骨折按照AO/ASIF分类： C113例，C223例，C318例。结果46例获得随访，时间5～28个月，平均14.6个月。骨折全部愈合，愈合时间12～20周，平均15.4周，无切口感染、内固定松动及断裂等。疗效参照改良的Casse-baum法评估：优14例，良29例，可6例，差5例；优良率79.6％。双钢板平行固定组优4例，良7例，可3例，优良率78.6％；垂直固定组优10例，良22例，可3例，差5例；优良率80.0％，组间比较优良率无统计性差异（ P＞0.05）。结论经尺骨鹰嘴截骨入路适用于所有C型成人肱骨远端骨折，而经肱三头肌双侧入路主适用于未累及滑车中央部的C1、C2型。平行或垂直双钢板固定稳定性好，可满足患者早期进行关节功能锻炼，疗效好，皆为治疗C型成人肱骨远端骨折的理想方法。
목적：탐토경후입로응용평행혹수직쌍강판고정치료성인C형굉골원단골절적방법화림상료효。방법2005년7월～2012년11월채용후입로쌍강판고정치료성인C형굉골원단골절54례，기중경굉삼두기쌍측입로18례，경척골응취절골입로36례；쌍강판평행고정14례，수직고정40례。골절안조AO/ASIF분류： C113례，C223례，C318례。결과46례획득수방，시간5～28개월，평균14.6개월。골절전부유합，유합시간12～20주，평균15.4주，무절구감염、내고정송동급단렬등。료효삼조개량적Casse-baum법평고：우14례，량29례，가6례，차5례；우량솔79.6％。쌍강판평행고정조우4례，량7례，가3례，우량솔78.6％；수직고정조우10례，량22례，가3례，차5례；우량솔80.0％，조간비교우량솔무통계성차이（ P＞0.05）。결론경척골응취절골입로괄용우소유C형성인굉골원단골절，이경굉삼두기쌍측입로주괄용우미루급활차중앙부적C1、C2형。평행혹수직쌍강판고정은정성호，가만족환자조기진행관절공능단련，료효호，개위치료C형성인굉골원단골절적이상방법。
Objective To explore the surgical management and clinical effects in adult patients with AO type C fractures of the distal humerus treated with perpendicular or parallel double plating methods through posterior approach.Methods From Jul.2005 to Nov.2012,54 adult patients with type C fractures of the distal humerus were treated using double plating method through posterior approach .Eighteen cases were treated through paratri-cipital approach and 36 through olecranon osteotomy approach;14 cases were fixed with parallel double plates and 40 with perpendicular double plates .According to the AO/ASIF classification,there were 13 cases of type C1,23 cases of type C2 and 18 cases of type C3.Results Forty-six patients were followed up for 5-28 months ( average 14.6 months).All fractures healed.The healing time was 12-20 weeks(average 15.4 weeks).There was no incision infection and failure of osteosynthesis .According to the Cassebaum scoring system ,there were 14 excellent cases ,29 good,6 fair and 5 poor.The excellent and good rate was 79.6%.In parallel double plating group ,there were 4 ex-cellent cases ,7 good and 3 fair.The excellent and good rate was 78.6%.In perpendicular double plating group , there were 10 excellent cases,22 good,3 fair and 5 poor.The excellent and good rate was 80.0%.No significant difference was found between the 2 groups (P>0.05).Conclusion Olecranon osteotomy approach is suited for all type C fractures of the distal humerus in adults .Paratricipital approach is major suited for type C 1,C2 fractures with intact central trochlea .Perpendicular or parallel double plating method has advantages of stable fixation ,early functional exercise and good clinical effects ,and they are all ideal methods for treating AO type C fractures of the distal humerus in adults .