Imatani Junya, Ogura Takashi, Morito Yoshiaki, Hashizume Hiroyuki, Inoue Hajime
Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, 1-17-18 Ifuku-cho, Okayama, Japan 700-0851.
J Shoulder Elbow Surg. 2005 Nov-Dec;14(6):611-5. doi: 10.1016/j.jse.2005.02.004.
The purpose of this study was to present a new internal fixation technique for transcondylar fractures of the humerus in elderly patients. Seventeen patients, aged older than 70 years, with displaced transcondylar fractures were treated by our new surgical method. All fractures were fixed by a customized AO small T plate and a transcondylar screw passed from the lateral epicondyle to the medial wall of the trochlea across the humeral condyle. The plate was hand-shaped, trimmed, and applied at the lateral side of the fracture site, and either a cannulated cancellous screw or an AO one-third tubular plate was applied at the medial side of the fracture site. All patients in this study had osteoporotic bone and a small distal fragment. They were followed up for a mean of 30 months (range, 24 to 60 months). Radiographically, union was achieved completely in all patients, and all except 1 had maintained the postoperative alignment. Bone graft or cement fixation was not required in any case. The assessment of the results by use of the modified Cassebaum's rating scale was excellent in 3 cases, good in 11, and fair in 3. With the custom AO small T plate and transcondylar screw fixation technique, the screw that passes through the humeral condyle provides good stability even in cases with a small osteoporotic fragment of the distal humerus. The screw does not damage the articular surface of the elbow joint, and stable fixation can be obtained even in osteoporotic bone.
本研究的目的是介绍一种针对老年患者肱骨髁间骨折的新型内固定技术。17例年龄大于70岁的移位型肱骨髁间骨折患者接受了我们的新手术方法治疗。所有骨折均采用定制的AO小型T形钢板和一枚经外侧髁穿过肱骨髁至滑车内侧壁的髁间螺钉进行固定。钢板经手工塑形、修剪后应用于骨折部位外侧，骨折部位内侧则应用空心松质骨螺钉或AO三分之一管状钢板。本研究中的所有患者均存在骨质疏松且远端骨折块较小。他们平均随访30个月（范围24至60个月）。影像学检查显示，所有患者均完全愈合，除1例患者外，其余患者均维持了术后对线。所有病例均无需植骨或骨水泥固定。采用改良的Cassebaum评分量表评估结果，3例为优，11例为良，3例为可。采用定制的AO小型T形钢板和髁间螺钉固定技术，即使在肱骨远端骨质疏松性小骨折块的情况下，穿过肱骨髁的螺钉也能提供良好的稳定性。该螺钉不会损伤肘关节的关节面，即使在骨质疏松的骨质中也能获得稳定的固定。
