基于Dubberley分型成人肱骨远端冠状面骨折的手术治疗

Open reduction and internal fixation based on Dubberley classification for displaced coronal shear fractures of the distal humerus in adults

[目的]探讨按照Dubberley分型肱骨远端冠状面骨折的手术治疗入路与临床结果。[方法]回顾性分析2014年2月~2018年12月本院收治的24例肱骨远端冠状面骨折患者,依据Dubberley分型选择手术入路进行开放复位内固定术。[结果]24例患者均顺利完成手术,无神经、血管损伤等严重并发症。24例中,14例,包括ⅠA型3例、ⅠB型2例、ⅡA型6例、ⅡB型2例和ⅢA型1例,采用单纯外侧入路,2例ⅢA采用外侧入路加辅助前外侧入路,2例ⅢA、6例ⅢB型采用后正中鹰嘴截骨入路。24例患者恢复患肢完全负重活动时间为(16.17±3.16)周。随术后时间推移,24例患者VAS评分显著下降(P<0.05),而肘伸屈ROM和MEPS评分显著增加(P<0.05)。影像方面,24例患者中,21例关节面解剖复位,2例关节面移位≤2 mm,1例关节面移位>2 mm。影像显示骨折愈合时间(9.83±1.39)周。至末次随访,1例现异位骨化,1例肱桡关节间隙略缩窄;24例患者均无内固定松动、移位或断裂以及骨缺血性坏死等影像征象。[结论]Dubberley分型有利于确定骨折类型和手术入路进行开放复位内固定,取得满意的临床结果。

[Objective]To explore the surgical approaches and the clinical outcomes of open reduction and internal fixation(ORIF)for displaced coronal shear fractures of the distal humerus in adults based on Dubberley classification.[Methods]A ret⁃rospective study was conducted on 24 adult patients who received ORIF for displaced coronal shear fractures of the distal hu⁃merus in our hospital from February 2014 to December 2018.According to Dubberley classification,the surgical approaches and ORIF techniques were selected individually in each patient.[Results]All the patients had operation performed smoothly without serious complications,such as nerve and blood vessel injuries.Of the 24 patients,14 patients had ORIF through the lat⁃eral approach only including type IA in 3,type IB in 2,type IIA in 6 and type IIIA in 1 patient,whereas 2 patients with type II⁃IA were through the lateral approach combined with an adjuvant anterolateral approach,and the remaining 8 patients had ORIF conducted by way of posterior midline approach with olecranon osteotomy,including type IIIA in 2 and type IIIB in 6 patients.The patients returned to full-weight bearing activity in(16.17±3.16)weeks postoperatively.As time went the VAS score signifi⁃cantly decreased,whereas the elbow extension-flexion ROM and MEPS score significantly increased in the 24 patients(P<0.05).With regard to radiographic assessment,the fracture reduction revealed by postoperative images was anatomic in 21 pa⁃tients,of articular displacement less than or equal to 2 mm in 2 cases and displacement more than 2 mm in 1 patient.The frac⁃ture healing achieved at(9.83±1.39)weeks after operation on average on images.To the latest follow-up,heterotopic ossifica⁃tion in 1 case and articular space narrowing in another case were found,whereas no loosening or breaking of implants,and no os⁃teonecrosis were noticed in anyone of them.[Conclusion]The Dubberley classification facilitates to determine appro⁃priate surgical approach and the fixation method selection to achieve satisfactory clinical outcomes for displaced coronal shear fractures of the distal humerus.