陈旧性肱骨远端冠状面骨折及其治疗

Treatment of old shear fractures of the distal humerus

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Mayo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。

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°, wlfile 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 intemal 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）. The 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 postoperatively. According to the Mayo elbow score, outcomes were rated excellent in 3 cases, good in 2 eases and fair in 1 case. The excellent and good rate was 83.3%. Conclusion Coronal fractures of capitulum humeri and humerus trochlea are easy to be misdiagnosed. However three dimensional CT reconstruction is helpful to definite diagnosis. Early postoperative exercise with the aid of a hinged fixator can render elbow satisfactory function.