肱骨干下1/3骨折回顾性统计与形态学分析  

Adult distal third diaphyseal humerus fracture:an epidemiological research and morphological analysis

作　　者：叶友友 吴春玲 林焱斌[1] 钟源 朱云哲 何福飞 YE Youyou;WU Chuning;LIN Yanbin;ZHONG Yuan;ZHU Yunzhe;HE Fufei(Department of Orthopaedics,Fuzhou Second Hospital,Fuzhou,Fujian 350007,China)

机构地区：[1]福州市第二医院创伤骨科,福建350007

出　　处：《中国骨与关节损伤杂志》2023年第9期921-925,共5页Chinese Journal of Bone and Joint Injury

基　　金：福州市科技计划项目(2021-S-161);福建省创伤骨科急救与康复临床医学研究中心(2020Y2014)。

摘　　要：目的 分析肱骨干下1/3骨折的X线形态学特征,进一步明确肱骨干下1/3骨折的定义并进行细化分型。方法 回顾性分析自2013-01-2020-12诊治的165例肱骨干下1/3骨折,整理记录患者的一般情况(性别、年龄、受伤部位、致伤原因等),统计所有肱骨干下1/3骨折患者桡神经损伤发生率、医源性桡神经损伤例数、手术方式及二次手术率,并根据X线影像学形态提出初步骨折分型。结果 本组桡神经损伤率为11.5%,146例行手术治疗,占比最高的手术方案是单钢板内固定。17例需行二次手术(11.6%),医源性桡神经损伤发生率为11.6%。初步将肱骨干下1/3骨折归纳为以下几类:Ⅰ型为横形、短斜形;Ⅱ型为斜形、螺旋形,又分为三个亚型,ⅡA型是左右成尖角、桡长尺短,ⅡB型是左右成尖角、桡短尺长,ⅡC型是前后成面;Ⅲ型为合并蝶形骨块的斜形、螺旋形,又分为两个亚型,ⅢA型合并尺侧蝶形骨片,ⅢB型合并桡侧蝶形骨片。本组骨折分型:Ⅰ型45例,ⅡA型5例,ⅡB型29例,ⅡC型8例,ⅢA型19例,ⅢB型59例。结论肱骨干下1/3骨折按骨折形态学可分为三型,该分型一致性较高,其中螺旋骨折伴尺侧蝶形骨块发生率最高,可为基础实验研究及临床手术入路、内固定方式提供参考意见。Objective To analyze the X-ray morphological characteristics of the distal third diaphyseal humerus fracture and to further clarify its definition and classification.Methods From January 2013 to December 2020,165 patients with distal third diaphyseal humerus fracture were retrospectively analyzed.The general information of the patients(gender,age,injury site,cause of injury,etc.)was collected.The incidence of radial nerve injury in patients with distal third diaphyseal humerus fracture,the number of iatrogenic radial nerve injuries,the surgical method,and the rate of secondary surgery were recorded.The preliminary fracture classification was proposed according to the X-ray imaging morphology.Results The rate of radial nerve injury in this group was 11.5%,and 146 cases were treated surgically,with the highest proportion of surgical methods be-ing single-plate internal fixation.Seventeen patients(11.6%)required secondary surgery.The incidence of iatrogenic radial nerve injury was 11.6%.The fractures in the distal third diaphyseal of the humerus were classified into the following types:type I:transverse,short oblique;type II:oblique and spiral shape,and divided into three subtypes.Type II A:sharp angle be-tween left and right,long radial and short ulnar,type II B:sharp angle between left and right,short radial and long ulnar,type II C:front and rear plane;Type II:an oblique and spiral shape with sphenoid bone fragment,and divided into two subtypes:type IIA with ulnar sphenoid bone fragment and type IB with radial sphenoid bone fragment.There were 45 cases of type I,5 cas-es of type II A,29 cases of type IIB,8 cases of type II C,19 cases of type IIA,and 59 cases of type IIBin this group.Conclu-sion The fracture of the distal third diaphyseal humerus can be classified into three types based on fracture morphology,and the classification has a high consistency.Spiral fracture with an ulnar butterfly fragment has the highest incidence,which can provide reference for basic experimental research as well as for the selectio

关 键 词：肱骨骨折 骨折分型 骨折形态学 

分 类 号：R683.4[医药卫生—骨科学]