空心螺钉结合支撑钢板治疗肱骨远端冠状面骨折

Cannulated screw combined with buttress plate for the treatment of transarticular shear fractures of the distal humerus

目的：探讨空心螺钉结合支撑钢板治疗肱骨远端冠状面骨折的临床疗效。方法：2008年7月至2011年12月，采用空心螺钉结合支撑钢板治疗17例肱骨远端冠状面骨折患者，男10例，女7例；年龄20-59岁，平均36．5岁。按照Bryan—Morrey和McKee分型：Ⅰ型8例，Ⅱ型1例，Ⅲ型3例，Ⅳ型5例。AO／ASIF分型：1383．1型10例，1383．3型7例。Dubberley分型：1A型5例，1B型2例，2A型2例，2B型2例，3A型4例，3B型2例。新鲜损伤11例，陈旧损伤6倒。均为闭合性损伤。观察术后并发症、肘关节活动度情况，并采用Broberg-Morrey评分系统对其疗效进行评价。结果：所有患者获随访，时间18～24个月，平均21-3个月。所有骨折获得骨性愈合，时间10～15周，平均12．5周。无骨折畸形或延迟愈合。术后2例外侧副韧带附着处出现骨化现象，2例肱骨小头前方关节囊出现异位骨化。肘关节活动度：伸（16±7）°，屈（115±9）°，前臂旋前（65±5）°，旋后（60±5）°。Broberg—Morrey评分92．4±4．64，结果：优7例，良8例，一般2例。结论：对于肱骨远端冠状面骨折，术前应根据肘部创伤X线片及CT检查进行骨折分型，采用空心螺钉和支撑钢板牢固固定骨折块并结合术后早期功能锻炼可使肘关节功能得到满意恢复。

Objective ：To investigate the clinical outcomes of cannulated screw combined with buttress plate in treating transarticular shear fractures of the distal humerus. Methods：From July 2008 to December 2011,17 patients with shear frac- tures of the distal humerus were treated with cannulated screw combined with buttress plate. Among them,included 10 males and 7 females aged from 20 to 59 years old （mean 36.5）. All the fractures were classified into type Ⅰ（ 8 cases）,type Ⅱ （1 case） ,type Ⅲ （ 3 cases） and type Ⅳ （ 5 cases） according to Bryan-Morrey and McKee classification. According to AO/ASIF classification, 10 cases were type 13B3.1,7 cases were type 13B3.3; according to Dubberley classification,5 cases with type 1A, 2 cases with type 1B,2 cases with type 2A,2 cases with type 2B,4 cases with type 3A,2 cases with type 3B. There were 12 cases with fresh injuries,4 cases with old injuries. All fractures were closed injuries. Complications and range of motion of elbow were observed, and clinical efficacy were evaluated by Broberg-Morrey standard. Results：All patients were followed up with a mean time of 21.3 months （ranged, 18 to 24）. All fractures obtained bone healing from 10 to 15 weeks with a mean of 12.5 weeks. No malunion or delayed healing occurred. Two cases occurred ossification in lateral collateral ligament attachment. 2 cases occurred heterotopic ossification in the capitellum in front of capsule joint. The range of elbow extension was （ 16±7）°, flexion was （115±9）° ,the average arc of pronation and supination was （65±5）° and （60±5）° respectively. According to Broberg-Morrey standard, there were excellent in 7 cases, good in 8 cases, fair in 2 cases, and average score was 92.44±4.64. Conclusion： For transarticular shear fractures of the distal humerus, classification should be performed according to preopera- tive X-ray and CT, cannulated screw and buttress plate combined and early function rehabilitation could recover elbow func- tion.