切开复位内固定治疗Gustilo I-Ⅱ型肱骨远端开放骨折

摘要

Objective :To analysis clinical effects of open reduction and internal fixation in treating Gustilo type I and Ⅱ patients with open distal humeral fracture. Methods :From 2013 May to 2017 June, 24 patient with Gustilo grade I and Ⅱ open distal humeral fractures were treated with open reduction and internal fixation, including 20 males and 4 females, aged from 14 to 65 years old with an average of (41.3±13.1) years old. According to Gustilo classification, 16 patients were type I,8 patients were type Ⅱ. Range of motion, complications and secondary surgery were recorded; elbow function were evaluated with VAS (visual analogue scale),MEPS (Mayo elbow performance score) and QuickDASH (quick disabilities of the arm,shoulder,and hand) at 12 months after operation. Results:All patients were followed up from 15 to 60 years with an average of(34.1±11.9) months. VAS score was 0 (0,2);flexion and extension ranged from 50 °to 145° with an average of (115.2± 26.1)°;the range of rotation ranged from 100°to 160°with an average of (147.7±17.0)°. MEPS score was for 75 to 90 (90.0± 9.1),and 14 patients got excellent result, 10 patients moderate. Quick DASH score was 4.6 (0,14.8). There were 22 patients occurred complications,such as ulnar nerve symptom and internal fixation irritation,and 10 patients accepted the second operation. Conclusion :Open reduction and internal fixation is a safe and efficient method in treating Gustilo type I and Ⅱ patients with open distal humeral fractures, which has an advantages of good range of movement and function score.%目的:探讨切开复位内固定治疗Gustilol-Ⅱ型肱骨远端骨折的临床疗效.方法:自2013年5月至 2017年6月采用切开复位内固定治疗24例Gustilo I-Ⅱ型肱骨远端开放骨折患者,其中男20例,女4例;年龄14? 65(41.3±13.1)岁;根据Gustilo分型,I型16例,Ⅱ型8例.记录患肘的活动范围、术后并发症及二次手术的情况,并于术后12个月时采用主观疼痛视觉模拟评分(visual analogue scale,VAS),Mayo肘关节功能评分(Mayo elbow performance score,MEPS)及快速肩臂手功能障碍评分量表(quick disabilities of the arm,shoulder and hand,QuickDASH)评价患肘功能恢复情况.结果:所有患者获得随访,时间15～60(34.1±11.9)个月.术后12个月VAS评分为0(0,2)分.术后患肘屈伸活动度为 50°～145°(115.2±26.1)°,旋转 100°～160°(147.7±17.0)°o MEPS 评分为 90.0±9.1,优 14 例,良 10 例. QuickDASH评分为4.6(0,14.8)分.并发症发生22例,包括尺神经症状、内固定激惹等,二次手术患者10例.结论:切开复位内固定是一种治疗Gustilo I-Ⅱ型肱骨远端开放骨折安全有效的方法,患者活动范围好,功能评分满意.