目的 探讨不同手术方法治疗Dubberley B型肱骨小头-滑车骨折的临床效果。 方法 采用回顾性病例系列研究分析2017年1月至2023年12月使用双螺纹螺钉（Herbert螺钉）或解剖锁定钢板（LCP）治疗的肱骨小头-滑车骨折患者136例，其中男性42例，女性94例。年龄30岁~78岁(平均54.2岁)。骨折按Dubberley分型：IB型65例，IIB型52例，IIIB 19型例。手术采用切开复位行单纯Herbert螺钉内固定或LCP固定。比较两种内固定方式的手术时间、末次随访时梅奥肘关节功能评分（MEPS）、肘关节伸屈活动度、前臂内外旋活动度以及并发症情况。 结果 患者术后获得随访10~46个月（平均28.6个月）。LCP组手术时间较Herbert组延长，差异具有统计学意义。术后患肢伸直角度、屈肘角度、前臂旋转功能Herbert组优于LCP组，MEPS LCP组较Herbert组低，差异不具有统计学意义。 结论 对于IB型，采用外侧或后侧入路，螺钉及钢板均可选择。对于IIB型以及IIIB型，后侧入路更具优势，钢板可提供坚强固定。
Abstract
Objective To investigate the clinical effect of different surgical methods in the treatment of Dubberley Type B humeral capitellum-trochlea fracture. Methods A retrospective case-series study was conducted in 136 patients with humeral cephalic and trochlear fractures treated with Herbert screws or anatomical locking plates(LCP) from January 2017 to December 2023, including 42 males and 94 females aged 30-78 years (mean 54.2 years). According to Dubberley classification, 65 cases were type IB, 52 cases were type IIB and 19 cases were type IIIB. Open reduction and internal fixation were used in all the surgeries, with Herbert screw fixation alone or screw fixation followed by anatomic locking plate fixation. The operative time of the two internal fixation methods were compared. At the last follow-up, the elbow function of the patients was scored using the Mayo Elbow-Performance Score, and the patients' elbow flexion range of motion, forearm internal and external rotation range and complications were recorded. Results Patients were followed up for 10 to 46 months (mean 28.6 months).. The operation time of LCP group was longer than that of Herbert group, and the difference was statistically significant. The Herbert group was superior to the LCP group in terms of postoperative limb extension Angle, elbow flexion Angle and forearm rotation, but the differences were not statistically significant. The postoperative MEPS of the LCP group was lower than that of the Herbert group, but the difference was not statistically significant. Conclusions For type IB, a lateral or posterior approach may be considered, with screw and plate options. For type IIB and Type IIIB, the posterior approach is superior and plate binding screws provide firm fixation.
关键词
肘关节骨折 /
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Dubberley /
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切开复位内固定术 /
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螺钉 /
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钢板
Key words
Elbow fracture /
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Dubberley classification /
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Open reduction and internal fixation /
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Screw /
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Plate
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基金
江苏省卫健委老年健康科研面上项目（LKM202 2021）；苏州市运动医学重点学科（SZXK202104）
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