抗滑移技术治疗肱骨小头骨折

目的：探讨抗滑移技术治疗Ⅳ型肱骨小头骨折的临床疗效。方法：收集2011年8月～2013年8月本医院收治的22例Bryan and MorreyIV型肱骨小头骨折患者，男9例，女13例；年龄17—71岁，平均45．5岁；其中左侧10例，右侧12例；21例为新鲜骨折，1例为陈旧骨折（伤后12周）。所有患者均采用外侧入路，2枚Herbert螺钉由前向后固定骨折，同时使用抗滑移微型接骨板固定，术后早期进行功能锻炼。结果：22例手术中均无血管、神经损伤，术后伤口一期愈合；所有病例获得随访，平均随访8．3个月（4—14个月），均获骨性愈合，临床愈合时间平均10周（8～12周），X线片显示21例解剖复位，1例患者术后骨折再移位，骨折畸形愈合。所有患者均未出现骨化性肌炎、创伤性关节炎、肱骨小头缺血性坏死等并发症。疗效评估使用Cassebanm评分系统，结果优良18例，可4例，优良率81-8％。平均活动度：屈肘124°，伸肘24°。结论：抗滑移接骨板治疗Ⅳ型肱骨小头骨折，术中骨折解剖复位，抗滑移接骨板抵消冠状面剪切应力，使骨折固定牢固，防止复位固定后再次移位，早期进行肘关节主动伸屈功能锻炼，临床效果满意。

Anti-slide technique for treatment of capitellum fracture

Objective： To investigate the curative effect of anti-slide technique for treatment of capitellum fracture type IV. Methods： From August 2011 to August 2013, 22 patients with capitellum fracture type IV （9 male and 13 female with an average age of 45.5 years） were treated in this hospital. Among them, fresh fracture 21, old fracture 1, 10 on left and 12 on right. All patients were treated with internal fixation using Herbert screws and anti-slide plates by lateral approach. Results： All patients were followed-up for 4-14 months, without any complications like ossifying myositis, traumatic arthritis, eapitellum ischemic necrosis and so on, noted. X-rays showed a bony union in all cases, anatomic reduction in 21 eases, post-op re-frac- tured and mal-union in 1 case. According to Cassebanm system, the curative effects were evaluated as ex- cellent and good in 18, fair in 4, with an excellent and good rate of 81.8%. The average ROM of elbow- joint was 124°of flexion and 24°of extend. Conclusion： Anti-slide plates for treatment of capitellum fracture type Ⅳ can get an intra-op anatomy reduction, firm fixation and effective outcome.