切开复位内固定治疗成人肱骨小头骨折伴或不伴后髁骨折效果比较

Effect of open reduction and internal fixation in the treatment of fracture of the capitellum complicated with or without posterior condylar fracture in adults

目的观察切开复位内固定在成人肱骨小头骨折伴或不伴后髁骨折患者中的应用价值。方法回顾性分析2010年1月1日至2013年6月1日收治的50例肱骨小头骨折伴或不伴后髁骨折患者的临床资料,患者均行切开复位内固定治疗,观察患者肘关节伸屈活动度、前臂旋转活动度和肘关节外翻稳定性情况,分析患者术后Mayo肘关节功能评分系统(MEPS)评分。结果患者患侧肘关节的伸直活动度均小于健侧对应活动度,患侧屈曲活动度和屈伸活动度大于健侧(P<0.05),但患者患侧肘关节的前臂旋转活动度与健侧前臂旋转活动度比较差异无统计学意义(P>0.05)。肱骨小头骨折伴后髁骨折患者的平均屈伸度小于不伴后髁骨折患者(P<0.05),且肱骨小头骨折伴后髁骨折患者的MEPS评分也明显低于不伴后髁骨折患者(P<0.05)。结论切开复位内固定可有效改善成人肱骨小头骨折患者肘关节活动度,患者若伴有后髁骨折则需加强治疗,巩固治疗效果。

Objective To evaluate the effect of open reduction and internal fixation for fracture of the capitellum complicated with or without posterior condylar fracture in adults. Methods The clinical data of 50 adult pa- tients with facture of capitellum complicated with or without posterior condylar fracture admitted in our hospital from January 1, 2010 to June 1, 2013 were retrospectively analyzed. All patients were treated by open reduction and internal fixation. Range of extension and flexion of elbow joint, forearm rotation, elbow joint valgus stability of all patients and MEPS score were statistically analyzed. Results Range of extension of ipsilateral elbow of patients were smaller than that of contralateral elbow, but range of flexion, range of extension and flexion of ipsilateral elbow were bigger than those of contralateral elbow （P〈0.05）. Forearm rotation of both sides patients had no statistically significant dif- ferences （P〉0.05）. The average range of extension and flexion of patients with capitellurn complicated with posterior condylar fracture were smaller than that of patients with capitellum not complicated with posterior condylar fracture （P〈0.05）. And MEPS score of patients with capiteUum complicated with posterior condylar fracture were lower than that of patients with capitellum not complicated with posterior condylar fracture （P〈0.05）. Conclusion Open reduc- tion and internal fLxation for fracture of capiteUum in adults can improve elbow motion, and the patients complicated with posterior condylar fracture should receive strengthened and consolidated treatment.