目的：观察解剖锁定接骨板治疗C型肱骨远端骨折以及术后规范化康复的疗效。方法2009年12月至2013年6月使用解剖锁定接骨板治疗17例C型肱骨远端骨折患者，其中男性6例，女性11例；年龄24～84岁，平均51．2岁。损伤原因：低能量损伤9例（低能量组）；高能量损伤8例（高能量组）。受伤至手术时间为1～30d，平均8．4d。术后患者开始规范化肘关节功能康复治疗。末次随访时记录患侧肘关节活动范围并采用M ayo肘关节功能评分。结果所有患者术后获9～48个月（平均18．59个月）随访，所有骨折均愈合，1例合并尺骨鹰嘴截骨处延迟愈合。末次随访时，肘关节伸直15．0°±10．2°，屈曲103．2°±16．3°，活动范围88．2°±22．8°。M EPS评分（83．9±19．2）分，优良率76．5％（13／17）。高能量组与低能量组MEPS评分分别为（71．9±22．5）分和（94．6 ± 4．9）分，差异有统计学意义（ P＝0．025）。结论 A O解剖锁定接骨板治疗C型肱骨远端骨折的疗效肯定，高能量损伤患者的预后较差，初始损伤因素影响患者肘关节功能恢复，规范化的康复治疗有助于肘关节功能恢复。“,”Background Among AO types ,C type distal humerus fracture is a very complicated intra‐articular fracture .The distal humerus metaphysis and the articular surface are easy to get severe smash ,which add more difficulties to the treatment .C type distal humerus fracture is complicated with bone defects ,soft tissue injury ,nerve injury ,osteoporosis and other symptoms ,which add to the unsteady fixation and can lead to adverse impacts to prognosis .AO distal humerus lock plates are paralleled plates that vertically fix the internal fracture .It designs to be anatomical plastotype and the distal point is fixed with the 2 .7mm screws .It is more flexible and convenient to use in the operation , and can effectively prevent the restoration from loosing .It′s especially suitable for those patients with complicated fractures and osteoporosis .Through a retrospective study on the 17 cases of C type distal humerus fracture treated by AO distal humerus lock plate in our hospital from December 2009 to June 2013 ,we observed and analyzed the curative effects on the elbow joints functions and the prognosis rehabilitation training .Methods General data:17 patients ,6 males and 11 females aging from 24‐84 years old with the average age 51 .2 years old were selected to be the study subjects .8 of them injured the left side and 9 of them injured the right side .16 cases were closed fracture and 1 case was openfracture .Injury reasons :9 cases were due to low energy injury (low energy group) who fell over ,and 8 cases were due to high energy injury (high energy group) including 3 cases of traffic accident injuries ,4 cases of high falling accident injuries and 1 case of belts w rapping injuries .AO types of the fracture:2 cases were of C1 type ,5 cases were of C2 type ,10 cases were of C3 type .Complicated injuries :1 case had ulnar nerve rupture ,1 case had ipsilateral olecranal fracture ,1 case had ipsilateral triceps brachii rupture ,1 case had ipsilateral proximal humerus fracture ,1 case had craniocerebral injury subarachnoid hemorrhage ,1 case had complications of perlvic fracture ,acetabular fracture , femoral neck fracture and malaria .The injury time was 1‐30 days before the operation time ,with an average time of 8 .4 days . There were 11 cases with operation done within 7 days ,3 cases with operation done from the 7th to the 14th day ,3 cases with operation done after the 14th day .The operation time of the patient who was complicated with malaria was delayed .Operation time and the rehabilitation methods :30 minutes before the operation , the patients were given antibiotics as prophylaxis .The patients had general anesthesia and lay down in lateral position .The fracture limb was wrapped with pneumatic tourniquet and the incision was from the postmiddle side of the elbow . The ulnar nerve was revealed and protected , and the operation was started from the olecroanon resected surface ,the distal humerus and the joint surface were revealed .The operators should be cautious of the osteotomy inside the olecroanon joint surface apterium ,and the osteotomy location was 2cm below the olecroanon point . In the operation , firstly both the inner side and lateral side of olecranon should be exposed and then performed osteotomy to the midpoint apterium between elecranon and trochlear .When performing the osteotomy ,the operators firstly used the thin saw blade to cut off from the dorsal cortical bone to the subchondral bone ,and then cut off the final joint surface by osteotome .The principles of fixing the distal humerus fracture were firstly recovering the evenness of the joint surface ,and then using 10mm kirschner pins temporally or permanently to fix beneath the articular cartilage .the distal humerus inner side and lateral side column were restored ,and then they were temporally fixed with kirschner pins .The fixation couldbe achieved by using the AO humerus inner side and lateral side anatomical lock plates .The radial side plate was placed to the radial dorsal side of lateral column , the ulnar plate was placed next to the inner side of bone crest . Anterior transposition of ulnar nerve was performed in all patients ,and those patients who were complicated with ulnar nerve rapture were given suture .It should be noted that the ulnar nerve should be out of touch of the internal fixation metals .Before closing the wound ,the patients should stretch their elbow joints and observed whether they ulnar nerve entrapment so as to rectify in time .Drainage tubes were placed after operation , and the drainage tubes should be taken away 24 hours after operation . Meanwhile ,the patients should be guided to have elbow joint functional exercise ,and keep doing the elbow joint flexion and extension movements ,mainly active movements .The patients should take indometacin from the beginning of operation to 6 weeks after the operation .Among all the study subjects ,5 cases adopted the tran‐ulnar osteotomy vertically ,12 cases adopted osteotomy from the V‐shape distal point .Osteotomy fixation methods :4 cases fixed with kirschner tension bands ,2 cases fixed with tension bands with plated ,11 cases fixed with wirerope bounding system .The normalized elbow rehabilitation process began after the operation:the patients will decide whether to use gypsum or external fixation for protection depending on their fracture fixation stability condition and the soft tissue injury conditions .And the protection period was 1‐3 weeks .For those patients who had mild injury and strong fixation ,they could start the active movements the next day after operation .The rehabilitation contents included:(1) elbow joint active flexion and extension movements .(2) shoulder joint active movements which include active lifting ,outstretch ,edxtorsion and internal rotation .(3) the hands functional exercise including clenching fists , separating fingers , closing fingers , fingers movements .(4 ) Rotation movement of the forearms . Rear rotation and forward rotation were requested .(5) the above‐mentioned movements should be done for 3 times per day ,and 10‐15 rounds each time .When the swelling condition of the elbow joints was improved ,the times of movements could be added accordingly .But if the joint pain and the swelling became more severe ,the times andthe time of movements should be reduced .6 weeks after operation ,the patients should start the joint strength training gradually when the fracture union condition indicated in the X‐ray film became better .6) Physiotherapy :the patients should have hot compress on the fraction for 5‐10 minutes before doing the upper limb active movements training ,and then cold compress on the same part for 5‐10 minutes after training .If the fracture of the patient were swollen ,this part should be performed magnet therapy for 20 minutes each day .Functional evaluation:At the last follow‐up visit ,the visitors recorded the lateral elbow joint movement ranges and adopted the Mayo elbow joint functions evaluation systems ,namely ,mayo elbow performance score and MEPS .The functions were evaluated from 4 aspects :the pain degree ,movements degree ,stability and living ability .The full scores are 100 points :90‐100 points is excellent ,75‐89 points is good ,60‐74 is ok ,less than 60 points is poor . Statistical treatment :SPSS 16 .0 statistical software was utilized .The ages of high energy injury and low energy injury ,the period from being injured and performed operation ,the elbow stretch angles , the elbow bending angles , the movement range and the MEPS evaluation were all adopted independent‐samples t test .TFisher test was adopted for the genders of both groups and the injury inner side and lateral side comparison .And P <0 .05 is set as t statistically significance .Results All patients were followed up for 9‐48 months and the average was 18 .59 months .All the fractures became union and no failure of internal fixation was found .In the last follow‐up visit ,the results were:the elbow joints extension 15 .0° ± 10 .2° ,flexion 103 .2° ± 16 .3° ,movement range 88 .2° ± 22 .8° ,MEPS evaluation (83 .9 ± 19 .2) points .11 cases were excellent ,2 cases were good ,2 cases were ok ,and 2 cases were poor ,the excellent and good rate was 76 .5% .The MEPS evaluation of high energy injury was (71 .9 ± 22 .5) points and the low energy injury was (94 .6 ± 4 .9) points ,the differences had statistically significance ( P=0 .025) .The prognosis complications include:1 case had delayed union in olecroanon osteotomy ,2 cases had ulnar nerve paralysis ,but all of them were recovered in the end .Conclusion The curative effects of C type distal humerus fracture treated with AO anatomical lock plate deserves to be approved .The prognosis of high energy injury patients is poor .The initial injury factors can affect the patients′elbow joints functional recovery .Normalized rehabilitation treatment helps the elbow joints functional recovery .