外侧Kaplan入路治疗成人肱骨远端冠状面骨折

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1、万方数据生堡置拄杂盍垫!!堡5且筮31鲞箍』期￡b也』Q趔望P，丛掣2Q!!，yQ!!丛，丛Q：§外侧Kaplan人路治疗成人肱骨远端冠状面骨折王磊陈云丰安智全张长青曾炳芳【摘要l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，l例术中游离外侧副韧带扩大显露。按Dubberley分型：lA型3例，lB型l例，2A型l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

2、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l~2年。平均1．4年。l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90(0。～150)，屈125。(1050一135。)，平均活动度1160。按Broberg—Money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(IB型l例，3B型3例)：肘关节平均活动度104。．Broberg-Morrey标准评分平

3、均为92．8分。绐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。【关键词】肱骨骨折；内固定器；外科手术【证据等级】治疗性研究Ⅳ级·491··创伤骨科·SurgicaltreatmentoftransarticularshearfracturesofthedistalhumerusinadultsthroughKaplanapproachWANGL

4、ei,CHENYun-fe％AⅣ历i·quart,ZHANGChang-qing,ZENGBing-fang．DepartmentofOrthopaedicSurgery,theSixthPeople’sHospitalAffiliatedto5如嘲桅JiaotongUniversity,Shanghai2D0_233,China【Abstract】ObjectiveToinvestigatethesurgicaltreatmentandoutcomeofdistalhumeralshearfracturesinaduI

5、tsthroughKaplanapproach．MethodsNinepatientswithclosedshearfractureofthedistalhumerusweresurgicallytreatedthroughKaplanapproachfromSeptember2005toSeptember2009．Thelat-eralcollateralligamentwagreleasedonlyinlcase．AllthefractureswereclassifiedintotypeIA(3cases)，type

6、1B(1ease)，type2A(1case)，type3A(1cage)andtype3B(3eases)accordingtoDubberleyclassifi—cation．Underthedirectvision，cannulatedscrewwasusedafteranatomicreductionWagconfirmedbyfluo-roscopy．ResultsAIlfractureswerereducedanatomicallywithoutanyneuralorvascularinjury．Onlylc

7、aseofgradelheterotopicOSSificationwasfoundl2—24monthspostoperatively．Therewereexcellentin4cages．andgoodin5cases．TheaverageBroberg-Morreyscorewas94．2．Theaveragearcofflexion-extensionWagl160．Astothe4cageswithposteriorcomminution．theaveragedscoreandthearcofflexion-e

8、xtensionWag92．8and104。，respectively．ConclusionThroughKaplanapproach，thereductionandinternalfixationofdistalhumeralshearfracturescanbemanipulatedsuccessfullywit