肱骨小头骨折的手术疗效分析

Clinical efficacy of operation treatment on capitellar fractures

[目的]探讨肱骨小头骨折手术治疗的疗效及其影响因素。[方法]自2006年1月～2009年5月采用切开复位内固定治疗29例肱骨小头骨折,其中空心钉固定18例;可吸收钉固定4例;空心钉结合可吸收钉固定4例;克氏针固定1例;克氏针结合可吸收钉固定1例;克氏针结合星形钢板固定1例。[结果]本组28例病人,29肘随访时间平均26.2个月(11～37个月),骨折于随访期内全部愈合。Ⅰ型对比Ⅲ型和Ⅳ型肱骨小头骨折术后肘关节平均伸曲度的差异有统计学意义(分别t=3.411,P=0.004;t=3.327,P=0.005)。Ⅲ型对比Ⅳ型肱骨小头骨折术后肘关节平均伸曲度的差异无统计学意义(分别t=-0.278,P=0.784)。本组出现3例异位骨化,2例迟发性尺神经炎,无肱骨小头缺血性坏死病例。按照Broberg和Morrey的肘关节评分标准进行评分:优13例;良11例;可5例,优良率82.76%。[结论]Ⅰ型肱骨小头骨折手术解剖复位内固定,早期功能锻炼能达到满意疗效,Ⅲ、Ⅳ型肱骨小头骨折常合并肘关节其他骨折,肘关节韧带损伤或肘关节脱位预后较差。

[ Objective ] To discuss curative effect of operation treatment on capitellar fractures and influence factors. [ MethodJ From January 2006 to May 2009, twenty-nine capitellar fractures were treated with open reduction and internal fixation, in which 18 cases were fixed with cannulated screws ,4 cases were fixed with absorbed screws ,4 cases were fixed with can- nulated screws and absorbed screws, 1 case were fixed with Kirschner wires, 1 case were fixed with Kirschner wires and plate. [ Result] The average duration of follow-up was 26.2months（ range 11 -37 months）, all fractures achieved complete union. Compared with the average ROM of flexion-extension of type I capitellar fractures to type III and type IV, there were significant difference（ t = 3.411, P = 0. 004, t = 3. 327, P = 0. 005 ）. Compared with the average ROM of flexion-extension of type III capi- tellar fractures to type IV, there was no significant difference （t = -0. 278,P = 0.784）. Three cases reported heterotopic ossifi- cation, two cases of ulnar nerve paralysis, none of capitellar necrosis was found. According to the functional rating scale of Brob- erg and Morrey, there were 13 excellent, 11 good and 5 fair results. [ Conclusion ] Type I fractures of eapitellum can get satisfac- tory function by treating with anatoiccal open reduction, internal fixation and early mobilization. Type III and type IV capitellar fracture often combined with other elbow fractures, ligment injury or elbow dislocation may have poor function.