战创伤致肱骨髁间骨折的治疗

The research and treatment of humeral intercondylar fracture caused by war trauma

肱骨髁间骨折是最难治疗的战创伤所致的关节内骨折之一。经过几十年的发展,肱骨髁间手术技术及内植物有了长足的发展。文章通过对Medline数据库、中国知网及万方数据库近些年特别是2020年以来有关肱骨髁间骨折文献进行查阅及总结,对髁间骨折的分型、治疗方法以及相应的并发症进行概述,详细分析每种治疗方法不同的适应证以及优缺点,介绍不同年龄段患者治疗方法的差异。文献表明,积极的切开复位内固定术仍是治疗肱骨髁间骨折的首选方式。经尺骨鹰嘴截骨入路能够充分暴露关节面,是最常用的手术入路,但存在截骨处不愈合等风险。肱三头肌两侧入路、肱三头肌翻转入路、肱三头肌腱膜舌形瓣入路可避免截骨,但对肱骨远端关节面缺乏有效暴露。随着“双柱”理论的推广,双钢板固定比单钢板具有更强的牢固性与灵活性。锁定加压钢板和3D打印接骨板固定具有独特的优势。关于儿童髁间骨折,应以简单有效的复位固定以及对骨骺损伤小为治疗原则。而对于高龄、骨质疏松严重的患者,则可应用全肘关节置换术。

Intercondylar fracture of humerus is one of the most difficult intra-articular fractures caused by war trauma.After decades of development,great progress has been made in humeral intercondylar surgical techniques and implants.Based on the recent literature review on intercondylar fracture of the humerus in Medline database,CNKI and Wanfang database,especially since 2020,we intend to give a brief overview of the classification,treatment methods and corresponding complications of intercondylar fractures,analyze in detail the different indications,advantages and disadvantages of each treatment method,and introduce the differences in treatment methods of patients at different ages.The literature shows that open reduction and internal fixation is still the first choice for the treatment of intercondylar humeral fractures.The ulnar olecranon osteotomy approach can fully expose the joint surface and is the most commonly used surgical approach,but there is a risk of non union at the osteotomy site.The paratricipital approach,the Bryan-Morrey approach,and the Campbell approach can avoid osteotomy,but it lacks effective exposure to the distal articular surface of the humerus.With the promotion of the double column theory,double plate fixation has stronger firmness and flexibility than single steel plate fixation.Locking complessiom plate and 3D printed bone plate fixation have unique advantages.Regarding children's intercondylar fractures,the treatment principles should be simple and effective reduction and fixation,as well as minimal damage to the epiphysis.For elderly patients with severe osteoporosis,total elbow replacement surgery can be applied.