成人肱骨遠端髁間（T或Y型）骨折

成人肱骨遠端髁間骨折(intercondylar fracture)，是一種不常見的骨折，它一直是骨控治療上的一個難題：近年來採用手術復位，穩固的內固定及早期主動的關節運動來治療，亡經漸漸形成一種趨勢。本院自民國72年2月至76年9月，總共有19例這種骨折是採用手術復位及內固定來治療，其中有14例經過至少半年以上的追蹤檢查。在這14例中，有10例是屬於Muller氏分類中的C3；結果的評估是根據Cassebaum氏分級法，病人主觀的評價及對重要日常生活功能的影響。客觀結果有7例評為優或良好；病人主觀評價平均是79.2百分比滿意；2/3的患者在重要的生活功能沒有困難。主要的併發症是神經壓迫症狀，沒有傷口發炎的病例，有一例內固定鋼板斷裂。綜合文獻報告及本院之結果顯示，儘速手術復位，穩固之內固定及術後早期(石膏去除後)關節運動是治療肱骨遠端T或Y型骨折成功之要件。在骨折癒合良好的情形下，取出內固定物，可能使功能進一步改善。經尺骨鷹嘴突做 ”V” 型切骨術之手術途經，在有限之經驗中，認為是值得採用之方式，且在手術中應例行檢查尺神經以避免術後神經壓迫症狀之出現。

關鍵字

髁間骨折；手術復位及內固定；術後運動

並列摘要

Intercondlar T or Y fractures of the distal humerus in adults is uncommon, and difficult to treat. In recent years immedi-ate open reduction, rigid interal fixation and early postoperative active range of motin have gradually become a trend. Nineteen patients with this fractures were treated at our hospital from Feb. 1983 to Sep. 1987. Fourteen of them were followed up for at least half an year. According to Muller’s classification, 10 of the followed patients belonged to type C3. The results were evaluated objectively with criteria proposed by W. H. Cassebaum, and subject-tively by the patients themselves in terms of percentage of satisfaction and important functions of daily life activity. Good or excellent results were recorded objectively in 7 cases ; subjective satisfaction reached 19.2%, and no problems were found in important daily life activity in two thirds of them. Nerve compression symptoms were the main complication ; there was no wound infection but plate fatigue fracture occurred in 1 case. Literature review and the experience of this series revealed that early open reduction, stable internal fixation and early postoperative joint movement after removal of cast are exxential to successful treatment of intercondylar T or Y fracture of the adult distal humerus. Provided that bony union is well, early removal of inter-nal fixation devices may achieve further improvement of elbow function. This lim-ited experience also suggests that transole-cranon osteotomy approach is recommend-able and routine intraperatvie examination of ulnar nerve should be done to avoid pos-toperative nerve compression symptoms.

並列關鍵字

intercondylar fracture ； open reduction and internal fixation ； postoperative movement

國際替代計量

成人肱骨遠端髁間（T或Y型）骨折

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