126例成人肱骨远端骨折的手术治疗分析(1)
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【摘要】目的：探讨成人肱骨远端骨折手术内固定的方法及临床疗效。方法：对126例肱骨远端骨折患者，按照不同的骨折类型采用不同的手术内固定方法，并进行相应的功能锻炼，定期随访术后骨折愈合及关节功能恢复情况。结果：126例肱骨远端骨折患者骨折均愈合完好，关节功能优良率达93.65%，各种不同手术内固定方法术后肘关节功能恢复比较差异无显著性(P>0.05)。结论：对于远端较复杂C型骨折采用切开复位平行双钢板螺丝钉固定或Y形钢板固定，对于B型骨折选用2-3枚拉力钉穿透对侧皮质固定或用单侧钢板固定，A型骨折用足够长的螺丝钉穿过对侧皮质固定，可获得坚强的内固定，肘关节功能恢复效果满意。
【关键词】肱骨；远端；骨折；分型；固定；手术
126 cases of adult distal humerus fractures analysis of
ZHUANG Zongxing
County, Sichuan Province, the Second People's Hospital of Sichuan double double 610 213
【Abstract】Objective To investigate the adult distal humerus fracture fixation and clinical efficacy. Methods 126 cases of distal humerus fractures in patients with different types of fractures according to different methods of surgical fixation, and the corresponding functional training, regular follow-up fracture healing and joint function after recovery. Results 126 patients with fractures of distal humerus fractures were healed in good condition, excellent rate of 93.65% joint function, a variety of different surgical methods of internal fixation of elbow joint function recovery after surgery was no significant difference (P> 0.05). Conclusion For the more complex C-type distal fractures with open reduction and parallel double plate screws or Y-shaped plate, for use 2-3 pieces of B-type fracture of the contralateral cortex through the fixed pulling nails or plate fixation with a unilateral, A-type fracture with screws long enough through the cortex of fixed, get a strong fixation, elbow joint function recovery results were satisfactory.
【Key words】humerus; distal; fracture; classification; fixed; surgery
成人肱骨远端骨折后常破坏关节面的完整，多是粉碎性骨折，最大限度的恢复肘关节功能，一直是创伤骨科医师追求的目标。我们对126例肱骨远端骨折的成人患者，按不同的骨折类型采取不同的手术内固定方法治疗，配合相应的功能锻炼，取得了满意复位及固定，术后患者关节功能恢复较好，现报道如下。
1资料与方法
1.1临床资料本组病例126例，男84例，女42例；平均年龄48.7岁。按AO/ASIF分型[1]：A型14例，B型36例，C型76例；多发性损伤12例，皮肤挫伤8例，合并原发性尺神经损伤4例。
1.2 手术方法臂丛麻醉或全麻，取肘后正中切口，充分暴露尺神经，小心予以保护。(1)手术入路：根据骨折具体情况选取尺骨鹰嘴截骨入路、经肱三头肌舌形瓣翻转入路，三头肌两侧劈开入路。(2)手术步骤：先对关节内骨折的关节面进行复位，用细克氏针临时固定，之后再对干骺端进行复位。(3)内固定方式：按骨折类型选用型号合适的重建钢板，对于较复杂C型骨折采用平行双钢板螺丝钉固定或Y形钢板固定，对于B型骨折选用2-3枚拉力钉穿透对侧皮质固定或用单侧钢板固定 ......
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