肘前外侧入路内固定治疗肱骨小头骨折的临床疗效

Clinical effect of elbow anterolateral approach with internal fixation in the treatment of capitellum fractures

目的探讨经肘前外侧入路螺钉内固定治疗肱骨小头骨折的临床疗效。方法2011年1月至2013年6月手术治疗肱骨小头骨折12例，按Bryan-Morrey分型：I型8例，Ⅱ型2例，Ⅳ型2例。手术经前外侧人路，AO空心螺钉固定。术后根据Broberg—Morrey肘关节功能评分进行疗效评价，同时进行影像学评估。结果12例患者术中未发现合并有外侧副韧带损伤，均无血管、神经损伤，术后伤口I期愈合。全部病例均获随访，随访8～26个月，平均16个月。骨折均临床愈合，时间5～9周，平均7．2周。术后肘关节屈伸活动度为（127．2±12．8）°，前臂旋转度为（154．6士15．3）°。术后Broberg—Morrey评分平均90．5分，优8例，良3例，差l例。结论肱骨小头骨折的治疗需按分型手术；前外侧入路可较好的暴露骨折，方便操作，空心螺钉固定牢固；早期肘关节功能锻炼，临床疗效满意。

Objective To investigate the clinical effect of elbow anterolateral approach with internal fixation in the treatment of capitellum fractures. Methods 12 patients with capitellum fractures were divided into types according to Bryan-Morrey classification： type I （n： 8）, type II （n= 2）, type IV （n= 2）. Patients were treated with anterolateral approach with AO eannulated screw fixation. Curative effect was evaluated according to Broberg-Morrey scale. Imaging evaluation was conducted. Results No lateral collateral ligament injury, blood vessels or nerve injury were found in patients. Primary healings were obtained after operation. All patients were followed up for 8 to 26 months postoperatively （averaged 16 months）. All fractures were healed at 5 to 9 weeks after operation （averaged 7.2 weeks）. Postoperative elbow flexion and extension was averaged （127.2士12.8）°and forearm rotation was averaged （154.6 士15.3）°. Postoperative Broberg-Morrey score was averaged 90.5. The 8 cases were excellent, 3 cases good and 1 case poor. Conclusions Operation should be applicated according to fracture classification in the treatment of capitellum fractures. Anterolateral approach is better to expose the fracture, which is convenient for operation, and AO cannulated screw fixation can fix the fractures firmly. Clinical effect is satisfactory when taking early functional exercise for elbow joint.