肱骨小头骨折分型对内固定方式及手术入路选择的影响  

Relationship between classification of capitulum humeri fracture and internal fixation methods and surgical approaches

作　　者：吴欢 孙志坚 李庭[1] 费晗 陈辰[1] 肖鸿鹄 米萌[1] 李长润 WU Huan;SUN Zhijian;LI Ting;FEI Han;CHEN Chen;XIAO Honghao;MI Meng;LI Changrun(Department of Trauma and Orthopaedics,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院创伤骨科,北京100035

出　　处：《中华骨与关节外科杂志》2022年第12期945-950,共6页Chinese Journal of Bone and Joint Surgery

基　　金：北京市百千万人才工程培养经费资助(2020A45)

摘　　要：目的:探讨肱骨小头骨折的两种常用分型对内固定方式及手术入路选择的影响。方法:回顾性研究2016年4月至2022年4月行切开复位内固定肱骨小头骨折患者75例,根据内固定方式进行分组,其中使用螺钉治疗的患者42例(螺钉组),接骨板联合螺钉固定治疗的患者33例(接骨板+螺钉组)。根据术前X线和CT检查结果,两组分别采用Bryan-Morrey分型和Dubberley分型进行分类。根据手术入路进行分组,其中使用外侧入路治疗的患者58例(外侧组),肘后尺骨鹰嘴截骨入路治疗的患者16例(后方组),外侧入路+内侧入路联合治疗1例(外侧+内侧组),采用Bryan-Morrey分型和Dubberley分型进行分类,再分别比较两种分型对内固定方式及手术入路选择的影响。结果:Bryan-Morrey分型组间固定方式差异具有统计学意义,进一步进行两两分型组间比较结果显示,Ⅰ型与Ⅲ型、Ⅳ型差异均具有统计学意义,其余两两组间差异均无统计学意义。Dubberley分型组间固定方式差异具有统计学意义,进行两两分型组间比较结果显示,ⅠA型与ⅡB型、ⅢA型、ⅢB型,ⅡA型与ⅡB型、ⅢB型差异均具有统计学意义,其余两两组间差异均无统计学意义。进一步将Dubberley分型分为A型和B型两个亚型进行两两比较,经过组间比较结果显示,不同分型内固定方式比较差异具有统计学意义。Bryan-Morrey分型组间位置比较差异无统计学意义;Dubberley分型组间位置比较差异具有统计学意义。将Dubberley分型分为A型和B型两组进行比较,发现不同Dubberley分型组间部位分布差异具有统计学意义,根据具体分布情况可知,A型中外侧占比明显高于B型。结论:在肱骨小头骨折的内固定选择和手术入路选择上,Dubberley分型较Bryan-Morrey分型更具指导意义。Bryan-MorreyⅠ型及DubberleyⅠA型骨折基本上使用螺钉固定即可,而Dubberley B型患者需加用接骨板固定;关于手术入路的选取�Objective:To explore the relationship between two common types of the capitulum humeri fracture and internal fixations as well as surgical approaches.Methods:A retrospective study was conducted on 75 patients with open reduction and internal fixation of the capitellar fracture from April 2016 to April 2022.The internal fixation methods were divided into two groups,including 42patients treated with screws(screw group)and 33 patients treated with plates and screws(plate+screw group).According to preoperative X-ray and CT,Bryan-Morrey classification and Dubberley classification were used for classification and comparison between the two groups;.According to the surgical approaches the patients were divided into three groups,including 58 patients treated by the lateral approach(lateral group),16 patients treated by the posterior olecranon osteotomy approach(posterior group),and 1patient treated by the combination of the lateral approach and the medial approach(external+internal group).Similarly,Bryan-Morrey classification and Dubberley classification were used for classification and comparison.Results:The difference of fixation methods between Morrey classification groups was statistically significant.Further comparison between the two classification groups showed that the difference between typeⅠand typeⅢand typeⅣwas statistically significant,and the difference between the other two groups was not statistically significant.The difference of fixation methods between Dubberley’s classification groups was statistically significant.Further comparison between the two classification groups showed that the differences between typeⅠA and typeⅡB,TypeⅢA as well as typeⅢB,and typeⅡA and typeⅡB,typeⅢB were statistically significant,and the difference between the other two groups was not statistically significant.Dubberley was further divided into two subtypes,type A and type B,and the results showed that there were statistically significant differences between different types of internal fixation methods.T

关 键 词：肱骨小头骨折 内固定 肘外侧入路 尺骨鹰嘴截骨入路 

分 类 号：R683.41[医药卫生—骨科学]