摘要
目的探讨治疗肱骨远端C型骨折时尺神经松解与筋膜下前置术的手术疗效。方法采用肘后侧正中切口入路,对40例肱骨远端关节内骨折(按AO分型C1型24例,C2型10例,C3型6例,其中9例伴有不同程度尺侧半手指麻木)的患者,采用尺骨鹰嘴"V"形截骨入路,重建肱骨远端的内外侧柱,并形成稳定的三角形框架结构的方法进行治疗。术前9例有尺神经症状者,术中均见尺神经有明显压迫,其中2例伴有尺神经的挫伤。术中保护尺侧上副血管并游离尺神经,骨折固定后将尺神经于筋膜下前置。除1例尺骨鹰嘴骨折与肘关节脱位患者术后石膏托保护3周外,其余病例术后早期进行被动功能训练。结果31例术前无尺神经损伤症状者术后无并发尺神经损伤症状。9例有尺神经症状者6例完全恢复,3例不同程度的恢复;按照中华医学会上肢部分功能评定试用标准评定:优7例,良1例,可1例,优良率为88.9%。35例经过平均16个月的随访(5例失访),骨折全部愈合,4例有轻度骨化性肌炎,占11.4%。按照Mayo clinic肘关节评分评定:优11例,良好17例,可5,差2例,优良率为80.0%。结论常规尺神经松解并进行筋膜下前置,便于肱骨远端关节内骨折的双柱固定,并可以防止术中尺神经损伤与术后进一步卡压的发生。
Objective To evaluate the surgical results of ulnar nerve neurolysis and subfascial anterior transposition in the treatment of type C distal humeral fractures. Methods Forty cases of type C （C1 in 24 cases, C2 in 10 cases, and C3 in 6 cases; numbness of the ring and little fingers in 9 cases） distal humeral fractures were studied. We used olecranon V-shape osteotomy approach and reconstructed lateral and medial columns of the distal humeral, thus to formed a stable triangular flame. Evidence of compression was noted in all 9 cases with prcoperative neurologic symptoms. Contusion of the ulnar nerve was seen in 2 cases of the 9 cases. Ulnar nerve was dissected along with the superior ulnar collateral artery bundle and transposed subfascially in all cases. Early rehabilitation was performed postoperatively in all but one case which required cast fixation for 3 weeks due to the accompanying olecranon fracture and elbow dislocation. Results Thirty-one cases that had no preoperative neurologic symptoms of the ulnar nerve remained normal postoperatively. Thirty-five cases were followed for an average of 16 months postoperatively. Five cases were lost for follow-up. Recovery of ulnar nerve function was complete in 6 cases and partial in 3 cases. The results were graded as excellent in 7 cases, good in 1 case, and fair in 1 case according to the upper limb functional assessment criteria of the Chinese Medical Association. The overall satisfactory rate was 88.9%. Of the 35 cases with sufficient follow-up, bone healing was observed in all cases. Four cases showed mild ossification with the rate of 11.4%. Elbow function was rated as excellent in 11 cases, good in 17 cases, fair in 5 cases and poor in 2 cases according to Mayo Clinic Elbow Performance Scores. Conclusion Ulnar nerve neurolysis and subfascial transposition can facilitate doublecolumn reconstruction in type C fracture of the distal humerus. Moreover, it is helpful to avoid injury to the ulnar nerve during the operation and prevent ulnar nerve compression af
出处
《中华手外科杂志》
CSCD
北大核心
2007年第6期333-335,共3页
Chinese Journal of Hand Surgery
关键词
肱骨骨折
骨折固定术
内
尺神经前置
Humeral fracturse
Fracture fixation,internal
Ulnar nerve transposition
