肱桡关节“接吻骨折”特点及治疗研究  

Study of characteristics and treatment of “kissing fracture” of humeroradial joint

作　　者：蒋燕 周子红[2] 魏长宝 唐文 徐可林 JIANG Yan;ZHOU Zihong;WEI Changbao;TANG Wen;XU Kelin(Department of Radiology,Wuxi Orthopaedic Hospital,Wuxi Jiangsu,214062,P.R.China;Department of Orthopaedics,Wuxi People’s Hospital,Wuxi Jiangsu,214062,P.R.China;Department of Orthopaedics,Wuxi Orthopaedic Hospital,Wuxi Jiangsu,214062,P.R.China;Department of Orthopaedics and Traumatology,Wuxi Traditional Chinese Medicine Hospital,Wuxi Jiangsu,214000,P.R.China)

机构地区：[1]无锡市骨科医院放射科,江苏无锡214062 [2]无锡市人民医院骨科,江苏无锡214062 [3]无锡市骨科医院骨科,江苏无锡214062 [4]无锡市中医院骨伤科,江苏无锡214000

出　　处：《中国修复重建外科杂志》2022年第11期1369-1373,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨肱桡关节“接吻骨折”临床特点以及治疗方法。方法 回顾分析2016年1月—2021年6月收治的12例肱桡关节“接吻骨折”患者临床资料。男8例,女4例;年龄15~75岁,平均41.9岁。致伤原因:跌倒伤7例,高处坠落伤3例,运动伤2例。受伤至入院时间2~72 h,中位时间2 h。桡骨头骨折根据Mason分型标准:Ⅰ型2例,Ⅱ型8例,Ⅲ型2例。肱骨小头骨折根据Grantham分型标准:Ⅰ型10例,Ⅱ型2例;其中4例GranthamⅠ型X线片检查漏诊,经CT和/或MRI检查确诊。合并肘关节其他损伤4例。桡骨头骨折采用螺钉或微型钢板内固定11例,保守治疗1例;肱骨小头骨折采用螺钉或钢板内固定9例,摘除1例,保守治疗2例。术后X线片复查骨折愈合情况;采用Mayo肘关节功能评分标准(MEPS)评价患肢功能恢复情况,检测肘关节活动度。结果 术后切口均Ⅰ期愈合,无早期相关并发症发生。患者均获随访,随访时间10~24个月,平均15.2个月。X线片复查示骨折均愈合,愈合时间2~3个月,平均2.3个月。末次随访时,肘关节屈伸活动度达65°~161°,平均136.9°;旋转活动度达70°~180°,平均149.2°。MEPS评分为70~100分,平均87.4分;获优8例、良2例、可2例,优良率83.3%。结论 肱桡关节“接吻骨折”临床少见,肱骨小头骨折程度一般较桡骨头骨折轻,GranthamⅠ型肱骨小头骨折单纯X线片检查易漏诊。此类型骨折按照关节内骨折处理原则治疗,可获得较好疗效。Objective To explore the clinical characteristics and treatment of “kissing fracture” of humeroradial joint.Methods A clinical data of 12 patients with “kissing fracture” of the humeroradial joint between January 2016 and June 2021 was retrospectively analyzed.There were 8 males and 4 females with an average age of 41.9 years(range,15-75 years).The fractures caused by falling in 7 cases,by falling from height in 3 cases,and by sports in 2 cases.The time from injury to admission was 2-72 hours(median,2 hours).According to Mason’s classification,the radial head fractures were rated as type Ⅰ in 2 cases,type Ⅱ in 8 cases,and type Ⅲ in 2 cases.According to Grantham’s classification,the humeral capitulum fractures were rated as type Ⅰ in 10 cases and type Ⅱ in 2 cases.Among them,4 cases of Grantham type Ⅰ humeral capitulum fracture were missed by X-ray film and confirmed by CT and/or MRI.Four cases were complicated with other injuries of elbow joint.The radial head fractures were fixed with screws or mini plate in 11 cases and treated conservatively in 1 case;the humeral capitulum fractures were fixed with screw or plate in 9 cases,removed in 1 case,and treated conservatively in 2 cases.X-ray film was used to evaluate the fracture healing;Mayo Elbow Performance Score(MEPS) was used to evaluate the functional recovery of the affected limb,and the range of motion(ROM) of the elbow joint of the affected limb was detected.Results All the incisions healed by first intention without early complications.All patients were followed up 10-24 months,with an average of 15.2 months.X-ray films showed that all fractures healed,and the healing time was 2-3 months,with an average of 2.3 months.At last follow-up,the ROM of flexion-extension of the elbow joint was 65°-161°,with an average of 136.9°;the ROM of rotation was 70°-180°,with an average of 149.2°.MEPS ranged from 70 to 100,with an average of 87.4;8 cases were excellent,2 cases were good,and 2 cases were fair;the excellent and good rate was 83.3%.

关 键 词：肱桡关节“接吻骨折” 桡骨头骨折 肱骨小头骨折 内固定 

分 类 号：R687.3[医药卫生—骨科学]