Kocher入路单纯空心螺钉固定治疗成人肱骨小头骨折的疗效分析

Fixation with cannulated screws alone via the Kocher approach for humeral capitulum fractures in adults

目的探讨Kocher入路单纯空心螺钉固定治疗成人肱骨小头骨折的疗效。方法回顾性分析2016年8月至2020年8月郑州市骨科医院上肢骨科治疗的16例患者资料。男10例,女6例;年龄36~62岁,平均45岁;左侧10例,右侧6例。骨折根据Ring分型:Ⅰ型3例,Ⅱ型3例,Ⅲ型6例,Ⅳ型4例。所有患者均采用肘外侧Kocher入路,骨折给予直视下复位,克氏针临时固定,最后置入空心螺钉固定。术后第2天进行肘关节主动屈伸功能锻炼,同时口服吲哚美辛预防异位骨化。末次随访时根据Mayo肘关节功能评分(MEPS)评定疗效,同时记录肘关节的屈伸活动度和前臂的旋转活动度。结果所有患者术后获10~19个月(平均14.3个月)随访。16例患者均获骨性愈合,愈合时间7~12个月(平均11.3个月),其中2例患者出现异位骨化。末次随访时根据MEPS评分:优8例,良6例,中2例;平均89.5分(73~95分)。末次随访时患者肘关节屈曲80°~130°(平均113°),伸直5°~30°(平均15°);前臂旋前62°~75°(平均67°),旋后50°~90°(平均75°)。结论对于成人肱骨小头骨折,通过外侧Kocher入路显露骨折断端,单纯空心螺钉固定骨折块,指导患者早期进行有效肘关节功能锻炼,术后疗效满意。

Objective To investigate the efficacy of fixation with cannulated screws alone via the Kocher approach in the treatment of adult humeral capitulum fractures.Methods From August 2016 to August 2020,16 patients with humeral capitulum fracture were treated at Department of Upper Limb Orthopedics,Zhengzhou Orthopaedic Hospital.They were 10 males and 6 females,aged from 36 to 62 years(average,45 years).The left side was affected in 10 cases and the right side in 6.According to the Ring classification,3 cases were typeⅠ,3 cases typeⅡ,6 cases typeⅢ,and 4 cases typeⅣ.All patients were treated with the Kocher approach on the lateral side of the elbow.After reduction under direct vision,the fractures were fixated temporarily with Kirschner wires and finally with cannulated screws.On the second postoperative day,the patients started active flexion and extension of the elbow joint and took indomethacin orally to prevent heterotopic ossification.At the last follow-up,the curative efficacy was evaluated according to the Mayo elbow performance score(MEPS).The flexion and extension of the elbow joint and the rotation of the forearm were also recorded.Results All patients were followed up for 10 to 19 months(mean,14.3 months)after surgery.Bony union was achieved after 7 to 12 monthes(average,11.3 monthes)in all the 16 patients,2 of whom developed heterotopic ossification.By the MEPS evaluation at the last follow-up,8 cases were excellent,6 good and 2 fair,scoring an average of 89.5 points(from 73 to 95 points).At the last follow-up,the elbow flexion ranged from 80°to 130°(averaging 113°),extension from 5°to 30°(averaging 15°),forearm pronation from 62°to 75°(averaging 67°),and forearm supination from 50°to 90°(averaging 75°).Conclusion When the fracture ends are exposed through the lateral Kocher approach,the fracture fragments fixated with cannulated screws only,and the patients encouraged to start elbow joint exercises in the early stage,the treatment of adult humeral capitulum fractures can result in satisfactory curative effects.