成人肱骨小头骨折的诊断与治疗

目的：探讨成人肱骨小头骨折的诊断、鉴别诊断及合理的骨折分型方法，据此选择相应的手术入路及内外固定策略。方法：回顾性分析北京积水潭医院自2008年9月至2014年1月收治的28例肱骨小头骨折患者，男18例、女10例，年龄14~66岁，平均34岁。Dubberley分型：ⅠA型6例、ⅠB型2例、ⅡA型8例、ⅡB型4例、ⅢA型4例、ⅢB型4例。手术入路：肘关节外侧入路16例、外侧加内侧入路1例、肘前入路2例、肘后入路9例；均以Herbert螺钉固定，7例加用支撑钢板，4例加用可活动铰链式肘关节外固定架。观察术后骨折愈合、肘关节活动度及并发症情况。结果：平均随访28.5个月，骨折平均愈合时间8周，肘关节屈伸活动度平均为112°（60°~150°），前臂旋转度平均为145°（100°~170°）。Broberg Morrey评分优良率91.2%，出现2例创伤性关节炎及2例肘关节僵硬。结论：应注意肱骨小头骨折的诊断与鉴别诊断，勿漏诊合并损伤；Dubberley分型能很好地显示骨折的严重程度，据此可以选择合适的手术入路及内外固定方式；术后早期、合理、有效的功能锻炼有助于肘关节功能的恢复。

Diagnosis and treatment of adult capitellar fractures

Objective:To discuss the diagnosis,differential diagnosis,classification methods and treat-ment of the capitellar fractures of the distal humerus.Methods:In the study,28 adult patients with the capitellar fractures were treated in Beijing Jishuitan Hospital from Sep.2008 to Jan.2014.There were 10 females and 18 males with an average age of 34 years (range:14-66 years).According to Dubber-ley classification:ⅠA type in 6 cases,ⅠB type in 2 cases,ⅡA type in 8 cases,ⅡB type in 4 cases,ⅢA type in 4 cases,and ⅢB type in 4 cases.Sixteen patients were treated with a single Kochr approach,1 with a lateral approach combined with a medial approach,2 combined with anterior elbow approach and 9 combined with posterior median approach.All of the fractures were fixed with Herbert screws,7 cases with support plates,and 4 cases with the hinged elbow external fixator.All of the pa-tients were followed up for clinical examination and radiograph check.They were evaluated with Broberg-Morrey score system.Results:The average follow-up time was 28.5 months (range 12 -72 months). The average bone union time was 8 weeks.The average ulnohumeral motion was 1 12°(60°-150°)and forearm rotation was 145°(100°-170°).The average Broberg-Morrey score was 92.5 points (range:62-100 points).The excellent and good rate was 91.8%.The complications of traumatic arthritis was in 2 cases and elbow stiffness was in 2 cases.Conclusion:Attention should be paid to the diagnosis and differential diagnosis of capitellar fractures without missing the combined injury.According to Dubberley classification,appropriate surgical approach and the internal and external fixed methods could be chosen. Early postoperative,reasonable and effective exercise is helpful to the recovery of elbow joint function.