成人肱骨远端低位通髁骨折的诊疗进展

肱骨远端低位通髁骨折在成年人中罕见,国内外报道较少,年龄呈双峰分布,多为老年人和年轻人。骨折线由内上髁延伸至外上髁,位置很低,为简单横行骨折,属于关节外、关节囊内骨折。标准肘关节正侧位X线片及CT平扫能够明确诊断。非手术治疗仅限于完全无移位骨折、无法耐受麻醉或晚期老年痴呆的患者。切开复位内固定是一线治疗方法,方式以平行及垂直双钢板为主,也有研究采用平行加垂直的"双柱4板"固定方式以及"十"字交叉双全螺纹螺钉固定。另外,有些特制后外侧柱钢板有外侧支撑作用,可置入横行螺钉。而全肘关节置换仅作为内固定失效后的补救措施。目前针对肱骨远端低位通髁骨折多为回顾性研究,证据等级较低。因此,亟需进行前瞻性及随机对照研究,针对不同内固定方式或全肘关节置换治疗低位通髁骨折的生物力学属性及临床疗效进行更进一步的研究。

Progress on diagnosis and treatment of low transcondylar fractures of distal humerus

Low transcondylar fractures of the distal humerus in adults is rarely seen and reported in literatures. It has a bimodal distribution in terms of age,affecting the elderly and younger patients. The fracture is characterized by a very low transverse intra-capsular and extra-articular fracture lines extending from the level of lateral epicondyle to medial epicondyle Standard elbow plain films and CT scans are crucial and indispensable for diagnosis. Conservative treatment is suitable for undisplaced fractures,patients who are intolerant of anesthesia,or people with advanced dementia. Open reduction and internal fixation (ORIF) is preferred. Parallel and orthogonal plate fixation are widely adopted while some researchers preferred crisscross-type screw fixation or bicolumnar 90-90 plating. In addition,some customized posterolateral plates are specially designed to be able to insert a transverse screw,functioning as lateral support. However,most of the recent researches conducted on low transcondylar fractures of the distal humerus are retrospective studies with relatively lower level of evidence compared to prospective and randomized controlled ones which remain a vacancy in this field. Therefore,further studies comparing the biomechanical properties and clinical prognosis of different configurations of internal fixation or total elbow arthroplasty for the treatment of low transcondylar fractures are needed in the future.