肱骨远端外侧解剖钢板固定治疗肱骨小头骨折

Treatment of humeral capitellum fracture using lateral anatomic plate for distal humerus

目的探讨肱骨远端外侧解剖钢板固定治疗肱骨小头骨折的临床疗效。方法回顾性分析2010年10月至2014年10月治疗的11例Dubberley Ⅱb、ⅢB型肱骨小头骨折患者资料。男7例，女4例；平均年龄33．1岁（24～71岁）。骨折按Dubberley分型：ⅡB型7例，ⅢB型4例。所有患者均使用肱骨远端外侧解剖钢板（带支撑）固定。记录骨折复位情况、骨折愈合时间和并发症情况。末次随访时采用Mayo肘关节功能评分（MEPS）评定肘关节功能。结果11例患者术后获12—35个月（平均16．1个月）随访。骨折均获愈合，平均愈合时间为3．2个月（2．5-5．0个月）。术后无一例患者发生肱骨小头缺血性坏死、骨折复位丢失。1例患者x线片示有创伤性关节炎表现，1例患者出现肘关节骨化性肌炎。末次随访时患侧肘关节平均屈曲活动度为121．2°（91．3°-142．2°），平均伸直活动度7．3°（4．5°～13．7°）；前臂旋前81．4°（53．5°-91．2°），旋后79．8°（65．3°-84．7°）。末次随访时MEPS评分平均89．8分，其中优8例，良2例，中1例。结论使用肱骨远端外侧解剖钢板（带支撑）治疗肱骨小头骨折可在直视下复位，固定牢靠，有利于肘关节功能恢复。

Objective To evaluate the surgical treatment of capitellum fractures of Dubberley types ⅡB and Ⅲ B using lateral anatomic plate for distal humerus. Methods From October 2010 to October 2014, 11 capitellum fractures of Dubberley types ⅡB and Ⅲ B were treated with open reduction and internal fixation with lateral anatomic plate for distal humerus （with support）. They were 7 males and 4 females, with a mean age of 33.1 years （from 24 to 71 years）. Seven cases were type ⅡB and 4 type ⅢB. Reduction, fracture union, and complications were documented. The elbow function was assessed by the Mayo elbow performance score （MEPS） at the last follow-up. Results All the 11 patients were followed up for 12 to 35 months （mean, 16. 1 months）. All fractures united after an average time of 3.2 months （from 2.5 to 5.0 months）. No avascular necrosis of the capitellum or reduction loss occurred. Traumatic arthritis was observed on the X-ray film of one case and heterotopic ossification in another. At the final follow-up, the mean elbow flexion was 121.2° （from 91.3° to 142.2°）; the mean elbow extension was 7.3°（from 4.5° to 13.7°）; the mean elbow pronation was 81.4° （from 53.5° to 91.2°）; the mean elbow supination was 79.8° （from 65.3° to 84. 7°）; the mean elbow MEPS was 89.8. Eight cases were rated as excellent, 2 as good and one as fair. Conclusion As it allows reduction under direct visualization, use of lateral anatomic plate for distal humerus （with support） for capitellum fractures of Dubberley types ⅡB and ⅢB can obviously improve fixation stability of the fracture which facilitates early functional recovery of the elbow.