陈旧性肱骨远端冠状面骨折及其治疗

目的 探讨陈旧性肱骨远端冠状面骨折的诊断与治疗.方法 自2005年以来,对6例陈旧性肱骨远端骨折进行诊断与治疗.其中肱骨小头冠状面骨折4例,肱骨滑车冠状面骨折2例;受伤至就诊时间为8～16周,平均10.5周;肘关节平均活动度伸(35±5)°,x/-±s,下同]、屈(50±10)°,前臂旋前(15±10)°、旋后(10±5)°.采用前外侧切口空心螺钉内固定,术后在带关节的外固定支架帮助下进行早期功能锻炼.结果 术后随访时间为4～18个月,平均11个月;骨折愈合时间为2～2.5个月,平均2.2个月.肘关节平均活动度为伸(15±9)°、屈(115±10)°,前臂旋前(65±5)°、旋后(70±5)°.1例并发尺神经麻痹症状者,经服用神经营养药物治疗,术后3个月恢复.按照Nayo肘关节评分标准评定:优3例,良2例,可1例;优良率为83.3%.结论 陈旧性肱骨小头与滑车的冠状面骨折易引起误诊,三维CT可明确诊断.术后在带关节的外固定支架帮助下进行早期功能锻炼,可获得较满意的关节功能.

Treatment of old shear fraclures of the distal humerus

Objective To investigate the diagnosis and treatment strategies of old coronal fracture of the distal humerus. Methods Since 2005, a total of 6 patients with old coronal fractures of the distal humerus underwent diagnosis and treatment. Of all cases, there were 4 old coronal fractures of capitulum humeri and 2 old coronal fractures of humerus trochlea. Time between injury and hospital visit ranged from 8 to 16 weeks (average, 10.5 weeks), The average range of elbow extension was 35°±5°, while the average range of elbow flexion was 50°±10°. Range of forearm pronation averaged 15°±10°, while that of forearm supination 10°±5°. All fractures were treated by open reduction and internal fixation with cannulated screw. Early postoperative exercise of the elbows was performed with the aid of a hinged fixator. Results All cases were followed up for 4 to 18 months (mean, 11 months). Ihe bone healing time ranged from 2 to 2.5 months (averag 2.2 months). Average range of elbow flexion was 115°±10°, while that of elbow extension was 15°±9°. The average range of forearm pronation and supination was 65°±5° and 70°±5°respectively. Transient ulnar nerve neuropathy occurred in one case which was treated with neurotrophic drugs and recovered 3 months postoperafivdy. According to the Mayo elbow score, outcones were rated excellent in 3 cases, good in 2 cases and fair in 1 case. The excellent and good rate was 83.3%. Condusion Coronal fractures of capitulum humeri and humerus trochlea are easy to bemisdiagnosed. However three dimensional CT reconstruction is heloful to definite diagnosis. Early postoperafive exercise with the aid of a hinged fixator can render elbow satisfactory function.