肘前入路可吸收螺钉治疗肱骨小头骨折9例分析

To evaluate the clinical result of anterior elbow approach and internal fixation of absorbable screw for treatment of capitellum fractures of 9 cases.

目的探讨采用肘前入路治疗肱骨小头骨折的固定方法和疗效。方法自2003年1月-2006年6月，采用肘前入路直视下复位骨折，分别于肱骨小头、滑车由前向后置入可吸收螺钉固定治疗肱骨小头骨折9例。男6例，女3例；年龄为15—21岁，平均15，5岁；左侧5例，右侧4例。致伤原因：骑自行车跌伤4例，骑摩托车跌伤3例，打篮球跌伤2例。本组均为新鲜闭合性骨折，未合并血管、神经损伤。手术时间为伤后3—5d。按陆裕朴等的分型，本组均为Ⅰ型肱骨小头一滑车骨折。结果本组9例患者均切口一期愈合，术后X线片显示骨折解剖复位。骨折临床愈合时间平均为4wk。随访时间最短6mo，最长3a，平均1．8a。无血管、神经损伤，肘关节骨化性肌炎、创伤性关节炎、肱骨小头缺血坏死等并发症。根据Morrey等制定的肘关节功能评定标准进行评价，结果优6例，良3例。结论肱骨小头骨折为关节内骨折，徒手整复很难成功，应行切开复位内固定术，手术采用肘前入路，可在直视下暴露骨折面和骨折块，准确复位，用可吸收螺钉有效固定，早期行肘关节主动伸屈功能锻炼，疗效较佳。

Objective To evaluate the clinical result of anterior elbow approch and internal fixation absorbable screw for treatment of capitulum humeri fractures of 9 cases. Methods From January 2003 to June 2006,9 patients of 6 males and 3 females with capitulum humeri fracture were chosen anterior approach of elbow. The fracture were treated with under direct vision and were fixed with absorbable screw. The left arms in 5 ,right in 4,the age of the group were from 15 to 21 years old,with the average of 15.5 years. 4 cases of falling from bicycle,3cases of falling from motorcycle ,2 cases injury of playing basketball. They were fresh and closed fractures, no nerves and blood vessels injury. The operative time was from 3 days to 5 days after injury. According to Lu Yupu＇s classification all were type l of capitulum humeri - trochlea fracture. Result lincisions of 9 patients were all healed by primary intention. The X - ray film of postoperation show that the fractures were anatomic reducing. The healing time was 4 weeks in average. All patints were followed up with a average 1.8 years, the shortest follow - up was 6 months, the longest follow -up was 3 years, no postoperative complications such as nerves and blood vessels injury, myositis ossificans ,post - traumatic arthritis, vascular necrosis of capitulum humeri. According to Morrey＇s the criterion of therapeutic effect of elbow joint＇s, result was 6 cases of excellent, 3 cases of good. Conclusion Capitulum humeri fractures is in the articular capusel. The close manipulation of it hardly succeeds,The treatment should be open accurate reduction associated with strong fixation. So the capitulum humeri fractures are suitable for opening reduced vision and fixing with absorbable screws through anterior elbow approach. The patients were encouraged to proceed for active rehabiliation early such as the elbow flexion - extension. Its short - term clinical outcomes is more excellent.