Zhang Jian, Lin Xu, Zhong Zeli, Wu Chao, Tan Lun
NO.1 Department of Orthopaedics, the Fourth People's Hospital of Zigong, Zigong Sichuan, 643000, P.R.China.
NO.1 Department of Orthopaedics, the Fourth People's Hospital of Zigong, Zigong Sichuan, 643000,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Jul 15;31(7):778-784. doi: 10.7507/1002-1892.201612123.
To compare the effectiveness of suspension fixation plus hinged external fixator with double plate internal fixation in the treatment of type C humeral intercondylar fractures.
Between January 2014 and April 2016, 30 patients with type C (Association for the Study of Internal Fixation, AO/ASIF) humeral intercondylar fractures were treated. Kirschner wire suspension fixation plus hinged external fixator was used in 14 cases (group A), and double plate internal fixation in 16 cases (group B). There was no significant difference in gender, age, injury cause, disease duration, injury side, and type of fracture between 2 groups ( >0.05).
There was no significant difference in operation time and hospitalization stay between 2 groups ( >0.05). But the intraoperative blood loss in group A was significantly less than that in group B ( <0.05); the visual analogue scale (VAS) score at 1 day and 3 days after operation in group A were significantly less than those in group B ( <0.05). Primary healing of incision was obtained in all patients of 2 groups, and no surgery-related complications occurred. The patients were followed up 6-24 months (mean, 12.3 months) in group A and 6-24 months (mean, 12.8 months) in group B. The self-evaluation satisfaction rate was 85.7% (12/14) in group A and was 81.2% (13/16) in group B at 3 months after operation, showing no significant difference ( =0.055, =0.990). Based on the improved Gassebaum elbow performance score at 6 months after operation, excellent and good rate of the elbow function was 78.6% (excellent in 5 cases, good in 6 cases, fair in 2 cases, and poor in 1 case) in group A and was 81.2% (excellent in 6 cases, good in 7 cases, fair in 2 cases, and poor in 1 case) in group B, showing no significant difference between 2 groups ( =0.056, =0.990). Heterotopic ossification occurred at 3 months after operation in 1 case of each group respectively. The X-ray films showed bony union in all cases; no loosening or breakage of screw was observed. The bone union time showed no significant difference between 2 groups ( =-0.028, =0.978). The time of internal fixation removal, the intraoperative blood loss, and VAS score at 1 day and 3 days after operation in group A were significant better than those in group B ( <0.05).
The suspension fixation plus hinged external fixator and double plate internal fixation for the treatment of type C humeral intercondylar fractures have ideal outcome in elbow function. But the suspension fixation plus hinged external fixator is better than double plate internal fixation in intraoperative blood loss, postoperative VAS score, and time of internal fixation removal.
比较悬吊固定联合铰链式外固定器与双钢板内固定治疗C型肱骨髁间骨折的疗效。
2014年1月至2016年4月，收治30例C型（国际内固定研究学会，AO/ASIF）肱骨髁间骨折患者。14例采用克氏针悬吊固定联合铰链式外固定器治疗（A组），16例采用双钢板内固定治疗（B组）。两组患者在性别、年龄、损伤原因、病程、伤侧及骨折类型方面差异无统计学意义（P>0.05）。
两组手术时间和住院时间差异无统计学意义（P>0.05）。但A组术中出血量明显少于B组（P<0.05）；A组术后1天和3天的视觉模拟评分（VAS）明显低于B组（P<0.05）。两组患者切口均一期愈合，未发生手术相关并发症。A组患者随访6～24个月（平均12.3个月），B组患者随访6～24个月（平均12.8个月）。术后3个月A组自我评估满意率为85.7%（12/14），B组为81.2%（13/16），差异无统计学意义（P=0.055，P=0.990）。根据术后6个月改良的加斯鲍姆肘关节功能评分，A组肘关节功能优良率为78.6%（优5例，良6例，可2例，差1例），B组为81.2%（优6例，良7例，可2例，差1例），两组差异无统计学意义（P=0.056，P=0.990）。两组各有1例患者术后3个月出现异位骨化。X线片显示所有病例均骨性愈合；未观察到螺钉松动或断裂。两组骨愈合时间差异无统计学意义（P=-0.028，P=0.978）。A组内固定取出时间、术中出血量及术后1天和3天的VAS评分均明显优于B组（P<0.05）。
悬吊固定联合铰链式外固定器与双钢板内固定治疗C型肱骨髁间骨折在肘关节功能方面均有理想疗效。但悬吊固定联合铰链式外固定器在术中出血量、术后VAS评分及内固定取出时间方面优于双钢板内固定。
