肘关节外侧入路治疗肱骨小头骨折的治疗体会及经验总结  

Summary and experience in the treatment of humeral capitellar fracture by lateral elbow joint approach

作　　者：王竹 王庚启 郑军[1] 端磊[1] 徐冰[1] 唐熙晨 吴泊逸 王秋根[2] 王建东 曹雷 毕春 邓国英 Wang Zhu;Wang Gengqi;Zheng Jun;Duan Lei;Xu Bing;Tang Xichen;Wu Boyi;Wang Qiugen;Wang Jiandong;Cao Lei;Bi Chun;Deng Guoying(Orthopedic Injury Center,Yueyang Hospital of Integrative Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;Department of Orthopaedic and Trauma,Shanghai First People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院骨伤中心,200437 [2]上海交通大学医学院附属上海第一人民医院创伤骨科,200080

出　　处：《中华肩肘外科电子杂志》2023年第3期235-241,共7页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：上海中医药大学附属岳阳中西医结合医院科研项目(2019YYZ10);上海市高级中西医结合人才培养项目(ZY(2018-2020)-RCPY-2010)。

摘　　要：目的总结肘关节外侧入路治疗肱骨小头骨折的治疗体会和经验,探讨其临床诊断、分型、手术内固定的方式。方法回顾性分析上海市岳阳中西医结合医院及上海市第一人民医院2017年1月至2021年12月创伤骨科收治的26例成人肱骨小头骨折患者,其中男11例、女15例;年龄28~71岁,平均38岁;左肘14例、右肘12例。Dubberley分型ⅠA型6例、ⅠB型2例、ⅡA型10例、ⅡB型2例、ⅢA型4例。有1例合并同侧的MasonⅡ型桡骨头骨折,1例合并尺骨鹰嘴骨折。手术入路均采用肘关节外侧入路,根据骨折块的位置和大小,复位后采用前后位或者后前位置入螺钉固定肱骨小头。对于Dubberley B型骨折累及滑车、外髁或后髁的外侧柱不稳定,辅用支撑钢板固定,恢复外侧柱的稳定。结果得到26例完整随访的患者,随访时间12~36个月。术中及术后未出现神经、血管损伤,骨折术后平均愈合时间10周。术后肘关节屈伸活动平均为112°(30~150°),前臂平均旋转功能为145°。根据Broberg-Morrey评分标准,26例患者平均得分为92.5分,术后优良率91.8%。有1例术后8个月复查时发现肱骨小头缺血坏死,2例轻度创伤后的肱桡关节炎(Broberg-Morrey1级);1例出现异位骨化(异位骨化分级I级),肘关节活动度尚好,未进行特殊处理。结论通过肘关节外侧入路的不同肌间隙进入,可以让骨折端获得更好的显露从而达到有效固定的目的。Background The humeral capitellar fracture is a less common periariticular fracture,often resulting from a coronal fracture of the humerus capitulum in the forearm impacted by the radius head during a fall.Kimball et al.pointed out in their report that the incidence of humeral capitellar fracture is only 1%,but it usually leads to severe elbow dysfunction.If the force applied is large,it may also cause damage to the radial head,external epicondyle,olecranon,humeral capitulum,posterior condyle,and medial and lateral collateral ligaments.Reconstruction of the condylar angle of the humerus,repair of the fractured articular surface,stabilization of the elbow joint,and early exercise are the keys to restoring the elbow joint function.However,the reduction and fixation of the fracture during surgery are often tricky,which requires our doctors to make detailed planning and design of surgical programs before surgery to achieve sound therapeutic effects.Objective To summarize the experience in treating humeral capitellar fracture by lateral elbow joint approach and to investigate its clinical diagnosis,classification,and internal fixation methods.Methods A retrospective analysis was performed on 26 adult patients with humeral capitellar fractures admitted to Shanghai Yueyang Hospital of Integrated Traditional Chinese and Western Medicine and Shanghai First People's Hospital from January 2017 to December 2021.Among them,11 were male,15 were female,14 were left and 12 were right.Their ages ranged from 28 to 71 years old,with an average age of 38.According to Dubberley classification,there were 6 cases of typeⅠA,2 cases of typeⅠB,10 cases of typeⅡA,2 cases of typeⅡB,and 4 cases of typeⅢA.There was 1 case with ipsilateral Mason II radial head fracture and 1 case with olecranon fracture.The lateral elbow approach was used in all cases.Depending on the location and size of the fracture fragment,the humeral capitulum was fixed with anteroposterior or posteroanterior screws after reduction.For Dubberley type B fracture

关 键 词：肱骨小头骨折 骨折固定术 手术入路 经验总结 

分 类 号：R687.3[医药卫生—骨科学]