摘要目的 探究肱骨髁间骨折切开复位内固定术后出现肘关节僵硬的危险因素. 方法 回顾性分析2013年1月至2017年5月北京积水潭医院创伤骨科行切开复位双钢板治疗的159例肱骨髁间骨折患者的资料.男83例,女76例;年龄14～79岁,平均42.6岁.根据末次随访时肘关节活动度及术后是否行肘关节松解手术分为2组:僵硬组(屈伸和/或旋转活动度＜ 100°和/或行肘关节松解术)和非僵硬组(屈伸及旋转活动度≥100°且未行肘关节松解术).采用logistic回归分析的方法,将年龄、性别、损伤侧别、损伤能量、骨折AO分型、开放/闭合骨折、是否合并其他骨折、是否合并神经损伤、受伤至手术时间、手术时长、手术入路、内固定构型、是否使用抗异位骨化药物、是否行取内固定手术等作为相关影响因素进行多因素分析. 结果 所有患者术后获10～63个月(平均32.0个月).末次随访时骨折均获愈合.僵硬组38例,非僵硬组121例.多因素分析结果表明,高能量损伤(OR =3.141,95％ CI1.396～7.070,P=0.006)和受伤至手术时间＞1周(OR=2.596,95％CI1.123 ～6.000,P=0.026)是肱骨髁间骨折术后肘关节僵硬的独立危险因素. 结论 高能量损伤及受伤至手术时间＞1周与肱骨髁间骨折术后肘关节功能恢复密切相关,是导致肱骨髁间骨折术后出现肘关节僵硬的独立危险因素,需在临床治疗中充分警惕并谨慎处置.

abstractsObjective To explore the risk factors for elbow stiffness after open reduction and internal fixation (ORIF) for intercondylar fractures of the distal humerus.Methods From January 2013 to May 2017,159 patients underwent ORIF for intercondylar fractures of the distal humerus with dual plating.They were 83 males and 76 females with a mean age of 42.6 years (from 14 to 79 years).They were divided into 2 groups according to their range of motion at the latest follow-up and the secondary elbow arthrolysis they had undergone or not.The stiffness group had extension-flexion and/or pronation-supination ＜ 100° and secondary elbow arthrolysis while the non-stiffness group had extension-flexion and pronation-supination ≥ 100° and no secondary elbow arthrolysis.Age,gender,fracture side,mechanism of injury,AO fracture classification,open/close fracture,additional fracture,preoperative nerve injury,time from injury to surgery,surgical approach,configuration of plating,medication for anti-heterotopic ossification and implant removal were analyzed as risk factors for elbow stiffness using Logistic regression analysis.Results The mean follow-up period for this cohort was 32.0 months (from 10 to 63 months).The latest follow-up showed fracture union in all the patients.The stiffness group had 38 patients and the non-stiffness group 121.Multivariate regression analysis showed that high energy trauma (OR =3.141,95％ CI 1.396 ～ 7.070,P =0.006) and time from injury to surgery ＞ one week (OR =2.596,95％ CI 1.123 ～ 6.000,P =0.026) were independent risk factors for elbow stiffness after ORIF for intercondylar fractures of the distal humerus.Conclusion The patients with high energy trauma and time from injury to surgery ＞ one week should be treated with caution and special care in clinical practice because the 2 factors are closely related to posttraumatic elbow stiffness after ORIF for intercondylar fracture of the distal humerus.