采用无头加压螺钉治疗头状骨和滑车大冠状面剪力骨折。
Large coronal shear fractures of the capitellum and trochlea treated with headless compression screws.
机构信息
Division of Arthritis and Joint Reconstruction, Florida Orthopaedic Institute, Tampa, FL 33637, USA.
出版信息
J Shoulder Elbow Surg. 2010 Jan;19(1):38-45. doi: 10.1016/j.jse.2009.05.012.
BACKGROUND
The purpose of this study is to retrospectively evaluate the clinical outcomes of 18 patients with large coronal shear fractures of the capitellum and lateral trochlea that underwent open reduction and internal fixation with headless compression screws.
METHODS
Eighteen patients were identified (16 women, 2 men) with an average age of 45 years and an average follow-up of 26 months. Fractures were classified according to the Dubberley classification as 11 type-1A injuries and 7 type-2A injuries.
RESULTS
All patients, with the exception of 1, had good to excellent functional results by the Broberg-Morrey scale (mean score, 93.3). Average arc of motion was 128 degrees in flexion/extension and 176 degrees in pronation/supination. Radiographically, 3 patients had subsequent development of avascular necrosis and 5 developed arthrosis. No significant negative correlation was noted between the development of avascular necrosis and clinical outcome. Minor complications occurred in 2 patients, but there were no re-operations.
CONCLUSION
Headless compression screw fixation allows for stable fixation in patients with large coronal shear fractures of the distal humerus without posterior comminution.
LEVEL OF EVIDENCE
背景
本研究旨在回顾性评估 18 例采用无头加压螺钉切开复位内固定治疗的大型冠状面肱骨小头和外侧滑车剪切骨折患者的临床结果。
方法
共纳入 18 例患者（16 名女性，2 名男性），平均年龄 45 岁，平均随访 26 个月。骨折根据 Dubberley 分类分为 11 型 1A 损伤和 7 型 2A 损伤。
结果
除 1 例外，所有患者均采用 Broberg-Morrey 评分评估，获得了良好至优秀的功能结果（平均评分为 93.3）。平均屈伸活动弧为 128°，旋前/旋后活动弧为 176°。影像学上，3 例患者随后发生了股骨头坏死，5 例患者发生了关节炎。股骨头坏死的发生与临床结果之间无明显负相关。2 例患者出现轻微并发症，但无再次手术。
结论
无头加压螺钉固定可稳定固定无后侧粉碎的肱骨远端大型冠状面剪切骨折。
证据等级
4 级。
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