| 外侧Kaplan入路治疗成人肱骨远端冠状面骨折 |
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| 引用本文： | 王磊,陈云丰,安智全,张长青,曾炳芳. 外侧Kaplan入路治疗成人肱骨远端冠状面骨折[J]. 中华骨科杂志, 2011, 31(5). DOI: 10.3760/cma.j.issn.0253-2352.2011.05.014 |
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| 作者姓名： | 王磊 陈云丰 安智全 张长青 曾炳芳 |
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| 作者单位： | 上海交通大学附属第六人民医院骨科,200233 |
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| 摘 要： | 目的 探讨经外侧Kaplan入路治疗成人肱骨远端冠状面骨折的手术方法及疗效.方法 2005年9月至2009年9月,采用肘关节外侧Kaplan入路治疗成人肱骨远端冠状面骨折9例,1例术中游离外侧副韧带扩大显露.按Dubberley分型:1A型3例,1B型1例,2A型1例,3A型1例,3B型3例;均为闭合损伤.直视下复位,经X线透视确认解剖复位后采用空心钉内固定,2例3B型骨折加用细克氏针内固定.结果 术中及术后无神经、血管损伤.术后X线片显示骨折解剖复位.9例均获随访,随访时间为1～2年,平均1.4年.1例肘关节前内侧1度异位骨化,未发现肱骨小头缺血性坏死或肱桡关节创伤性关节炎,无内固定松动或断裂.肘关节活动度:伸9°(0°～15°),屈125°(105°～135°),平均活动度116°.按Broberg-Morrey评分标准,平均94.2分;优4例,良5例.后方粉碎性骨折共4例(1B型1例,3B型3例):肘关节平均活动度104°,Broberg-Morrey标准评分平均为92.8分.结论 成人肱骨远端冠状面骨折累及肱骨小头和滑车,Kaplan入路能较好地显露骨折范围并完成手术操作,同时保护外侧副韧带的完整性,短期临床随访疗效较满意.Dubberley分型注重骨折严重程度及预后,有利于术者制定相应的手术计划.Abstract：Objective To investigate the surgical treatment and outcome of distal humeral shear fractures in adults through Kaplan approach.Methods Nine patients with closed shear fracture of the distal humerus were surgically treated through Kaplan approach from September 2005 to September 2009.The lateral collateral ligament was released only in 1 case.All the fractures were classified into type 1A (3 cases),type 1B (1 case),type 2A (1 case),type 3A (1 case) and type 3B (3 cases) according to Dubberley classification.Under the direct vision,cannulated screw was used after anatomic reduction was confirmed by fluoroscopy.Results All fractures were reduced anatomically without any neural or vascular injury.Only 1 case of grade 1 heterotopic ossification was found 12-24 months postoperatively.There were excellent in 4 cases,and good in 5 cases.The average Broberg-Morrey score was 94.2.The average arc of flexion-extension was 116°.As to the 4 cases with posterior comminution,the averaged score and the arc of flexion-extension was 92.8 and 104°,respectively.Conclusion Through Kaplan approach,the reduction and internal fixation of distal humeral shear fractures can be manipulated successfully with lateral collateral ligament intact,and the short-term outcome is satisfactory.Dubberley classification which focused on the severity and prognosis is helpful to make a surgical plan.
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| 关 键 词： | 肱骨骨折 内固定器 外科手术 |
Surgical treatment of transarticular shear fractures of the distal humerus in adults through Kaplan approach |
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| WANG Lei,CHEN Yun-feng,AN Zhi-quan,ZHANG Chang-qing,ZENG Bing-fang. Surgical treatment of transarticular shear fractures of the distal humerus in adults through Kaplan approach[J]. Chinese Journal of Orthopaedics, 2011, 31(5). DOI: 10.3760/cma.j.issn.0253-2352.2011.05.014 |
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| Authors: | WANG Lei CHEN Yun-feng AN Zhi-quan ZHANG Chang-qing ZENG Bing-fang |
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| Abstract: | Objective To investigate the surgical treatment and outcome of distal humeral shear fractures in adults through Kaplan approach.Methods Nine patients with closed shear fracture of the distal humerus were surgically treated through Kaplan approach from September 2005 to September 2009.The lateral collateral ligament was released only in 1 case.All the fractures were classified into type 1A (3 cases),type 1B (1 case),type 2A (1 case),type 3A (1 case) and type 3B (3 cases) according to Dubberley classification.Under the direct vision,cannulated screw was used after anatomic reduction was confirmed by fluoroscopy.Results All fractures were reduced anatomically without any neural or vascular injury.Only 1 case of grade 1 heterotopic ossification was found 12-24 months postoperatively.There were excellent in 4 cases,and good in 5 cases.The average Broberg-Morrey score was 94.2.The average arc of flexion-extension was 116°.As to the 4 cases with posterior comminution,the averaged score and the arc of flexion-extension was 92.8 and 104°,respectively.Conclusion Through Kaplan approach,the reduction and internal fixation of distal humeral shear fractures can be manipulated successfully with lateral collateral ligament intact,and the short-term outcome is satisfactory.Dubberley classification which focused on the severity and prognosis is helpful to make a surgical plan. |
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| Keywords: | Humeral fractures Internal fixators Surgical procedures,operative |
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