后入路平行或垂直双钢板固定治疗成人C型肱骨远端骨折的比较研究

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，经尺骨鹰嘴截骨人路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。

Comparison of perpendicular or parallel double plate fixation to treat AO type C fractures of the distal humerus in adults

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 eases 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 monthsI. All fractures healed. The healing time was 12-20 weeks（average 15.4 weeks}. There was no incision infection and failure ofosteosynthesis. 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 C1, 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.