CAJ | 학술논문

目的：探讨抗滑移钢板治疗肱骨远端 B3型骨折的手术方法和效果。方法自2010年1月至2013年6月,我科应用抗滑移钢板治疗17例肱骨远端 B3型骨折患者,按 AO 分型：B3.1型10例,B3.3型7例,全部采用肘关节外侧入路,术中应用抗滑移钢板结合3.0 mm HCS 无头空心钉固定。结果所有患者均获得随访,术后随访时间6~12个月,平均8个月。无感染和血管、神经损伤,无骨化性肌炎发生,骨折完全愈合。肘关节活动度：伸10°,屈110°,Broberg-Morrey 标准评分平均为90.5分,优良率88.2%。结论应用抗滑移钢板结合 HCS 治疗肱骨远端 B3型骨折,可以获得牢固而有效的固定,允许早期功能锻炼,能达到满意临床效果。
목적：탐토항활이강판치료굉골원단 B3형골절적수술방법화효과。방법자2010년1월지2013년6월,아과응용항활이강판치료17례굉골원단 B3형골절환자,안 AO 분형：B3.1형10례,B3.3형7례,전부채용주관절외측입로,술중응용항활이강판결합3.0 mm HCS 무두공심정고정。결과소유환자균획득수방,술후수방시간6~12개월,평균8개월。무감염화혈관、신경손상,무골화성기염발생,골절완전유합。주관절활동도：신10°,굴110°,Broberg-Morrey 표준평분평균위90.5분,우량솔88.2%。결론응용항활이강판결합 HCS 치료굉골원단 B3형골절,가이획득뢰고이유효적고정,윤허조기공능단련,능체도만의림상효과。
Background Coronal fracture of distal humerus is a rare intra-articular injury involving the articular surface of capitellum and trochlea,and it accounts for approximately 0.5%-1.0% of the fractures of elbow. Fractures of this type are easily missed. Numerous surgical approaches and types of internal fixation have been reported in literatures,but no conclusions are formed.From January 2010 to June 2013,1 7 patients with type B3 fractures of distal humerus were surgically treated with anti-glide plates and 3.0 mm HCS headless cannulated screws through lateral elbow approach to investigate the operative methods and their outcomes.Methods (1 )General information:From January 2010 to June 2013,1 7 patients with type B3 fractures of distal humerus were surgically treated with anti-glide plates,including 9 male and 8 female.The age ranged from 25-71 years and the average age was 42.1 years.Nine cases fractured in left side and 8 cases in right side. Causes of injury:fall from body height in 13 cases,motor accident in 3 cases and fall from meters high in 1 case.All patients were closed injury with no nerve or vascular damage.According to the AO classification,ten cases were type B3.1 fracture and seven were type B3.3.Through the lateral elbow approach,anti-glide plates combined with 3.0 mm HCS headless cannulated screws were used after anatomical reduction.The operation time from injury were 3-4 d.(2 )Operative methods:After successful brachial plexus block or general anesthesia,the patient was placed in supine position with pneumatic tourniquet applied.An incision of about 8 cm was made from 5 cm proximal to the lateral epicondyle of humerus,along the lateral humerus downward across epicondyle to the level of radial head.After each layer was opened,the muscular layer was dissected between the extensor carpi radialis muscle and extensor digitorum muscle.The carpi radialis muscle origin was reflected and the lateral elbow joint capsule was incised from proximal to distal to expose the capitellum and trochlea. Intra-articular hematoma, fragments and cartilage were carefully debrided during the operation. Fracture fragments were anatomically reduced and provisionally fixed by Kirschner wire.The 3 mm HCS headless cannulated screws were chosen for fixation from anterior to posterior or vice versa after satisfactory reduction had been checked under intraoperative fluoroscopy.An anti-glide plate or T plate was used for moulding.The plate should be placed near but not protrude to the articular surface. The full range of motion of elbow joint was checked.It should be clear that the plate would not block normal flexion.Reduction of the fracture and screw length was confirmed by fluoroscopy with C arm. The wound was closed in layers and drainage device was removed within 48 hours postoperatively.(3) Postoperative Management:Antibiotics were used to 30 min before operation and within 24 hours postoperatively.Indomethacin was taken orally for the first 6 weeks with 25mg each time and 3 times per day.Active and passive motions of elbow joint were begun when patient could tolerate after surgery,and the range of motion was increased gradually.All patients were routinely followed up at the 1st,2nd,3rd and 6th month after operation.Results All patients were followed up for 6 to 12 months with an average of 8 months.The fractures had full union with no infection,vascular and nerve damages,or myositis ossificans.No complications such as heterotopic ossification of elbow joint,traumatic arthritis,ischemic necrosis of capitellum,loosening or breakage of internal fixation and loss of reduction were seen.The mean range of moiton of elbow joint was 10°of extension and 1 10°of flexion.The Broberg-Morrey score averaged 90.5 with 8 excellent cases,7 good cases,1 normal case and 1 bad case,and the excellent and good rate was 88.2%.Conclusion With the application of anti-glide plate combined by 3.0mm HCS,the treatment of type B3 fractures can get a reliable and effective fixation, allow early functional exercise, and achieve satisfactory clinical outcomes.