微型锁定钢板垂直或平行技术治疗Dubberley B型肱骨小头骨折的临床疗效

Clinical effects of mini-locking plate with vertical or parallel technology for treatment of Dubberley type B capitellar fractures

目的探讨微型锁定钢板垂直或平行技术治疗DubberleyB型肱骨小头骨折的临床疗效。方法采用回顾性病例系列研究分析2010年1月-2016年1月应用微型锁定钢板垂直或平行技术手术治疗的17例肱骨小头骨折患者临床资料，其中男12例，女5例；年龄23～77岁，平均56．4岁。骨折按Dubberley分型：IB型2例，ⅡB型6例，ⅢB型9例。手术均采取肘关节后外侧Kocher入路，骨折在解剖复位后先使用克氏针及微型螺钉固定，再使用微型锁定钢板利用垂直或平行钢板技术进行固定。记录手术时间、术中出血量。术后观察骨折块位置，评判愈合情况，是否出现肱骨小头缺血性坏死、异位骨化和创伤性关节炎。末次随访时，采用Mayo肘关节功能评分（MEPS）对患者肘关节功能进行主客观评分，同时记录肘关节的屈伸活动度、前臂旋转度以及肘关节的内侧稳定性。结果手术时间50～90min，平均60min；术中出血g0～120ml，平均60ml。患者均获随访12～24个月，平均12．1个月。骨折解剖复位12例，接近解剖复位5例。患者均无血管、神经损伤。术后10～12d伤口均I期愈合。骨折愈合时间为8—12周，平均11．4周。末次随访时x线片示骨折均愈合良好，未出现骨折复位丢失、内固定松动或断裂、肱骨小头缺血性坏死、创伤性关节炎、肘关节异位骨化等并发症。所有患者MEPS为60～100分，平均87．6分；根据MEPS评定疗效：优13例，良3例，可1例，优良率为94％。末次随访时，肘关节平均活动度为伸直6°（0°～10°），屈曲118°（90°～130°）；前臂平均旋转前70°（60°～90°），平均旋转后82°（70°～90°）；内侧应力试验均不存在不稳定。结论微型锁定钢板垂直或平行技术治疗Dubberley B型肱骨小头骨折并发症少，术后可早期进行功能锻炼，短期临床随访疗效满意。

Objective To investigate the clinical effects of mini-locking plate with vertical or parallel technology in the treatment of Dubberley type B capitellar fractures. Methods A case series study was done on clinical data of 17 cases of Dubberley type B capitellar fractures treated through opera- tion with vertical or parallel mini-locking plate. There were 12 males and 5 females, with age range of 23- 77 years （ mean 56.4 years）. The fractures were classified according to the Dubbedey system, including type Ⅰ B in 2 cases, Ⅱ B in 6 and type m B in 9. The operations were conducted through the Kocher approach at posterior-lateral rear elbow joint and the fractured bone was fixed firstly with Kirschner wire and mini screws after resetting and then with vertical or parallel mini locking plate. The surgery time and bleeding volume during the surgery were recorded. The position of fracture, healing, avascular necrosis of capitellum, heterotopic ossification, and traumatic arthritis were evaluated. At the final follow-up, the Mayo elbow performance score （MEPS） was used to evaluate the function of elbow, and flexion and extension of the elbow, swing of the forearm and inner stability of the elbow joint were evaluated. Results The surgery time was 50-90 minutes （mean 60 minutes）. The bleeding volume during surgery was 40-120 ml （mean 60 ml）. All patients were followed up for 12-24 months （mean 12.1 months）. Anatomical reduction was seen in 12 cases and almost anatomical reduction in 5. None had vessel or nerve wound, and the wound was healed at phase I within 10-12 days after operation. The clinical frac- ture healing time was 8-12 weeks （mean 11.4 weeks）. At the final follow-up, the fractures were well healed without complications like fracture reduction loss, ischemic necrosis of the humerus, traumatic ar- thritis or heterotopic ossification of the elbow joint. MEPS in all cases was 60-100 points （ mean 87.6 points）. MEPS assessment result was excellent in 13 cases, good in 3 and fair in 1, with the excellent rate of 94%. At the final follow-up, the average activity of the elbow was 6° （0°-10°） for extension and 118°（90°-130°） for flexion,the average forearm pronation was 70° （60°-90°） , the average forearm supination was 82°（70°-90°）, and the inner stress test showed no instability. Conclusion Vertical or parallel mini-locking plate in the treatment of Dubberley type B capitellar fractures is associated with few complications, early functional exercise after operation, and satisfactory short-term outcome.