摘要
背景:金属植入物内固定治疗年青肱骨远端骨折患者具有明显的优势,优良率为65%～100%。老年此类骨折患者由于骨质疏松和全身状况等原因,是否有必要接受金属植入物的内固定治疗干预,尚缺乏验证。目的:探讨金属植入物内固定治疗老年患者肱骨远端骨折手术效果,并与保守治疗及年青患者作比较。方法:选择2002-01/2007-06皖南医学院弋矶山医院骨一科收治的27例肱骨远端骨折老年患者,年龄68(60～76)岁;其中20例肘关节实施开放复位金属植入物内固定治疗,7例进行保守治疗。术后3,6,12周临床和影像学评估分析患者伸屈功能、关节面台阶和前倾角,并与文献中中青年患者内固定治疗效果进行比较。结果与结论:27例均获得随访,随访7～28个月,其中26例骨性愈合。金属植入物内固定组1例不愈合,为非感染性骨不连,患者因全身情况而拒绝进一步治疗;无钢板断裂,2例存在螺钉松动,3例克氏针松动,但不需要手术干预。金属植入物内固定组患者伸屈功能、关节面台阶和前倾角评定结果及优良率明显优于保守治疗组(P<0.01)。内固定治疗组不愈合率(骨折部位和截骨部位)、感染、异位骨化、神经损伤以及和金属植入物相关的症状与文献中年中青年患者比较差异无显著性意义。与其他关节内骨折一样,老年肱骨远端骨折患者也需要金属植入物内固定治疗干预,只要遵循基本的外科和内固定的原则,保持前倾角和关节的完整性,均能获得一定的恢复。
BACKGROUND： In young patients, open reduction and internal fixation with plate fixation are advantageous which yields 65%-100% good and excellent results. Due to osteoporosis and poor whole-body condition, whether elderty patients need internal fixation of metallic implants is not clear. OBJECTIVE： To investigate the treatment outcome of fractures of distal humerus using plate and to compare the treatment outcome with that of treated non-surgically or young patients. METHODS： From January 2002 to June 2006, 27 elderly patients with distal humerus fracture treated in the First Department of Orthopaedics, Yijisan Hospital, Wannan Medical College were recruited. Their mean age was 68 years （60-78 years）. Open reduction and internal fixation were performed in 20 cases. Seven elbows were treated nonoperatively. Patients were followed up at 3, 6, and 12 weeks, the clinical and radiologic assessments were graded to evaluate the function of the elbow, articular step and the angle of distal humeral tilt. The outcomes were compared with those from the young patient treated with internal fixation. RESULTS AND CONCLUSION： All the cases were followed up for 7 to 28 months. Bony union occurred in 26 cases, 1 case suffered aseptic nonunion. The patient refused the additional treatment for poor whole body condition. No implants broke. Though the screws of 2 cases and the k-wires of 3 cases were loosing, it was not necessary for further operation. The function of the elbow, articular step and the angle of distal humeral tilt of the surgically treated group were obviously superior to the non-surgically group （P 0.01）. Rates of complications of the elder treated surgically were observed to be comparable to those described in the literature for younger patients. There was no difference about the rates of the nonunion （including fracture site and olecranon osteotomy site）, infection, heterotopic ossification nerve injury and the symptoms related with implants. Similar to the other intra-articular fracture, the internal fixation is beneficial for the distal humerus fracture in elderly patients as the angle the humerus tilt and integrity of the articuli were restored with the basic principle of surgery and inter fixation.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2010年第22期4150-4154,共5页
Journal of Clinical Rehabilitative Tissue Engineering Research
