切开复位内固定治疗青少年肱骨小头骨折  

Open reduction and internal fixation for capitellum fractures in adolescents

作　　者：方文来[1] 吴剑彬[1] 汤骏[1] 陈华[1] 

机构地区：[1]温州医科大学附属第二医院创伤骨科,325027

出　　处：《中华创伤骨科杂志》2017年第4期346-348,共3页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨青少年肱骨小头骨折的临床特点、损伤机制及切开复位内固定治疗的疗效。方法对2010年1月至2015年1月期间收治的14例青少年肱骨小头骨折患者资料进行回顾性分析。男12例，女2例；年龄12—16岁，平均13．7岁。骨折按Dubberley分型：IA型2例，IIA型8例，ⅢA型3例，HIB型1例。归纳其临床特点及损伤机制，末次随访时根据Mayo肘关节功能评分评定疗效，记录患侧肘关节的屈伸活动度及前臂旋转活动度。结果14例患者术后获6～18个月（平均12个月）随访，均在3个月内获骨折愈合，1例患者出现畸形愈合。13例患者末次随访时患肘伸屈活动度平均为120．60（110°～135°），患侧前臂旋转活动度平均为160．3°（150°～175°）。末次随访时Mayo肘关节功能评分：优12例，良1例。3例患者出现轻度创伤性关节炎。结论青少年肱骨小头骨折通常是不伴有后髁骨折的DubbedeYA型骨折，其损伤机制为在肘关节伸直过程中外翻应力作用下桡骨小头撞击肱骨小头所致，明确诊断后，切口复位内固定常能取得良好的效果。Objective To report the clinical outcomes of open reduction and internal fixation for capitellum fractures in adolescents. Methods From January 2010 to January 2015, 14 adolescents with eapitellum fracture were admitted to our department. They were 12 males and 2 females, aged from 12 to 16 years （13.7 years）. By the Dubberley classification, we had 2 cases of type IA, 8 cases of type HA~ 3 cases of type ]H A and one of type ]H B. We summarized their clinical characteristics and injury mechanisms. At the last follow-up, the therapeutic efficacy was assessed by the Mayo elbow function scores, and the ranges of motion of the elbow and forearm on the affected side were recorded. Results The 14 patients obtained an average follow-up of 12 months （from 6 to 18 months） . All the cases achieved fracture union within 3 months, but malunion appeared in one. At the last follow-up, the ranges of flexion and extension of the affected elbow av- eraged 120.6° （from 110° to 135°）, and the ranges of lateral rotation of the affected forearm averaged 160. 3° （from 150° to 175°） . According to the Mayo scores at the last follow-up, the elbow function was rated as ex- cellent in 12 and as good in one. Mild traumatic arthritis occurred in 3 cases. Conclusions CapiteIlum fractures in adolescents are often Dubberley type A ones without a complicated fracture of the posterior condyle. Usually, the capitellum is impacted by the radial head in the process of elbow extension with valgus stress. After definite diagnosis, open anatomical reduction and reasonable and reliable internal fixation can result in good clinical results.

关 键 词：肘关节 骨折固定术 内 青少年 损伤机制 

分 类 号：R726.8[医药卫生—儿科]