CAJ | 학술논문

目的探讨微型钢板治疗肱骨远端冠状面骨折的手术方法及疗效. 方法 2008年1月至2012年1月采用微型钢板治疗22例肱骨远端冠状面骨折患者,男13例,女9例;年龄23～62岁,平均40.4岁.骨折按Dubberley分型:ⅠA型6例,ⅠB型2例,ⅡA型7例,ⅡB型3例,ⅢA型2例,ⅢB型2例;骨折按AO/OTA分型:B3.1型9例,B3.3型13例.术前均行肘关节正、侧位X线片和CT检查,明确骨折部位、粉碎程度及移位情况.手术均采取后外侧入路,骨折解剖复位后在克氏针和螺钉固定的基础上采用微型钢板进行防滑固定.术后支具固定2～3d,2周后开始功能康复锻炼. 结果所有患者术后获12 ～ 24个月(平均15.6个月)随访.骨折临床愈合时间为9～12周,平均10.4周.未见肘关节骨化性肌炎、创伤性关节炎、肱骨小头缺血性坏死、内固定物松动或断裂等并发症.末次随访时根据Mayo肘关节功能评分系统评定疗效:优12例,良7例,可3例,优良率为86.4％;评分为60 ～100分,平均86.9分. 结论肱骨远端冠状面骨折累及肱骨小头和滑车应根据骨折分型进行术前计划,术中骨折复位后在克氏针和螺钉固定的基础上采用微型钢板进行防滑固定,可早期进行肘关节功能锻炼,疗效满意.
목적 탐토미형강판치료굉골원단관상면골절적수술방법급료효. 방법 2008년1월지2012년1월채용미형강판치료22례굉골원단관상면골절환자,남13례,녀9례;년령23～62세,평균40.4세.골절안Dubberley분형:ⅠA형6례,ⅠB형2례,ⅡA형7례,ⅡB형3례,ⅢA형2례,ⅢB형2례;골절안AO/OTA분형:B3.1형9례,B3.3형13례.술전균행주관절정、측위X선편화CT검사,명학골절부위、분쇄정도급이위정황.수술균채취후외측입로,골절해부복위후재극씨침화라정고정적기출상채용미형강판진행방활고정.술후지구고정2～3d,2주후개시공능강복단련. 결과 소유환자술후획12 ～ 24개월(평균15.6개월)수방.골절림상유합시간위9～12주,평균10.4주.미견주관절골화성기염、창상성관절염、굉골소두결혈성배사、내고정물송동혹단렬등병발증.말차수방시근거Mayo주관절공능평분계통평정료효:우12례,량7례,가3례,우량솔위86.4％;평분위60 ～100분,평균86.9분. 결론 굉골원단관상면골절루급굉골소두화활차응근거골절분형진행술전계화,술중골절복위후재극씨침화라정고정적기출상채용미형강판진행방활고정,가조기진행주관절공능단련,료효만의.
Objective To discuss the surgical treatment of coronal fractures of the distal humerus with a mini-plate.Methods Twenty-two cases of coronal fracture of the distal humerus were treated with a mini-plate between January 2008 and January 2012.They were 13 males and 9 females,with an average age of 40.4 years (from 23 to 62 years).According to Dubberley classification:there were 6 cases of Type ⅠA,2 Type ⅠB,7 Type ⅡA,3 Type ⅡB,2 Type ⅢA and 2 Type ⅢB.By the AO/OTA classification,there were 9 cases of type B3.1 and 13 type B3.3.All the cases were examined by anterioposterior and lateral X-ray and CT scan of the elbow to determine the location,comminution and displacement of the fracture.Anti-sliding fixation with a mini-plate was performed after anatomic reduction of the fracture and internal fixation with kirschner wires and screws through a lateral surgical approach.Brace fixation was maintained for 2 to 3 days postoperation.Functional rehabilitation was encouraged 2 weeks postoperation.Results All the 22 cases were followed up for an average of 15.6 months (from 12 to 24 months).All fractures healed after a mean time of 10.4 weeks (from 9 to 12 weeks).No such complications occurred as elbow myositis ossificans,traumatic arthritis,capitellum avascular necrosis,internal fixation loosening or breakage.According to the Mayo elbow performance scores which ranged from 60 to 100 points (average,86.9 points),12 cases were excellent,7 good and 3 fair,giving a good to excellent rate of 86.4％.Conclusions Since coronal fractures of the distal humerus involve the capitellum and the trochlea,preoperative plans should be made according to the specific fracture classification.The fracture can be treated with anti-sliding fixation with a mini-plate after anatomic reduction of the fracture and internal fixation with kirschner wires and screws to achieve satisfactory outcomes.