摘要
目的探讨严重肱骨髁部创伤后骨不连合并骨缺损的治疗方法并评价其远期效果。方法回顾性分析1996年5月至2014年5月收治的创伤后肱骨髁部骨不连合并骨缺损患者28例,男17例,女11例;年龄16~65岁,平均38.5岁;初始骨折按AO/ASIF肱骨髁部骨折分型:A3型9例,B1型2例,C2型6例,C3型11例;受伤距最后一次手术时间7~55个月,平均22.3个月。术前曾行1次手术18例,2次手术6例,3次手术3例,3次以上1例。术中清理骨不连端瘢痕组织后,根据骨缺损大小采用同等大小自体髂骨块解剖性重建肱骨髁内和/或外侧柱,内固定25例,肘关节置换3例。术前肘关节活动度平均为:伸17.9°(5°~65°),屈91.2°(85°~125°)。结果 28例患者均获随访,随访时间2.5~10.5年,平均4.6年。术后切口均一期愈合,随访未发现植骨块移位、内固定松动、断裂、骨不连,畸形愈合、迟发性尺神经炎等并发症,其中2例肘关节前方发生异位骨化。术后平均骨愈合时间5.7个月(4~10个月)。末次随访时肘关节活动度平均为:伸9°(0°~40°),屈122°(105°~145°)。采用改良的Cassebaum评分系统评定肘关节功能:优11例,良10例,中6例,差1例,优良率75%。结论肱骨髁部骨不连合并骨缺损严重影响肘关节功能,采用自体髂骨解剖性重建肱骨髁的内外侧柱,恢复肘关节力线,配合术后早期积极的功能锻炼,可以达到良好的骨折愈合,使肘关节的功能得到明显改善。
Objective To explore the use of autogenous iliac bonegraft for the anatomical reconstruction of severe humeral condylar nonunion and bone defect after trauma.Methods From May 1996 to May 2014,28patients（17male,11female）with humera condylar nonunion and bone defect were retrospectively analyzed.The average age was38.5years old（range 16~65）.According to AO/ASIF system,primal fractures were classified.There were 9type-A3,2type-B1,6type-C2 and 11type-C3 fractures.The average span from trauma to this operation was 22.3months（range7~55）.The approach of olecranon osteotomy was used in all patients.The medial and lateral humerus condyle was reconstructed with iliac autograft and shape memory compressive connector,cannulated nail,anatomical locking compressive plates were applied for fixation.Results 28 patients were followed with an average of 4.6（range 2.5~10.5）years.The averaged time of bone healing was 5.7（range 4~10）months.All the incisions healed primarily.There was no hardware failure,loss of reduction,secondary nonunion and tardive ulnar neuritis.Ectopic ossification before joint developed in one case and affected the joint function of elbow.According to modified Cassebaum scoring system,the results were excellent in 11 cases,good in 10 cases,fair in 6cases and poor in 1case.The excellent and good rate was75%.Conclusion The humeral condylar bone defects seriously affect the function of elbow joint.Anatomical reconstruction of medial and lateral condyle by autogenous iliac bone can restore the shape of elbow and alignment.Through early function exercise,elbow joint function can improve evidently.
出处
《实用骨科杂志》
2017年第1期13-16,共4页
Journal of Practical Orthopaedics
关键词
髂骨
肱骨髁
骨不连
骨缺损
内固定
重建
iliac bone
condyle of humerus
nonunion
bone defect
internal fixation
reconstruction
