Sanchez-Sotelo Joaquin
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA.
Instr Course Lect. 2012;61:203-13.
Fractures of the distal humerus can be challenging to treat. Advances in imaging, internal fixation, and arthroplasty have resulted in improved management of these injuries. Preoperative CT with three-dimensional reconstruction allows a better understanding of fracture patterns and helps the surgeon to select the best treatment options. Parallel plating techniques often provide stable internal fixation constructs, even in fractures with severe comminution. Precontoured periarticular plates facilitate internal fixation. More attention is now paid to recognizing and managing bone loss through metaphyseal shortening and/or bone grafting. Elbow arthroplasty appears to provide good early outcomes for elderly patients with severe elbow injury. Distal humeral hemiarthroplasty can be considered for elbow fractures with severe damage to the articular surface if the patient is too young and active to comply with the restrictions recommended after total elbow arthroplasty. Advances are still needed to reduce the overall complication rates associated with the treatment of distal humeral fractures.
肱骨远端骨折的治疗颇具挑战性。影像学、内固定及关节置换技术的进步使得这些损伤的处理得到了改善。术前进行三维重建的CT扫描有助于更好地了解骨折类型，并帮助外科医生选择最佳治疗方案。即使是严重粉碎性骨折，平行钢板技术通常也能提供稳定的内固定结构。预塑形的关节周围钢板便于内固定。现在更加注重通过干骺端缩短和/或植骨来识别和处理骨缺损。对于肘部严重损伤的老年患者，肘关节置换术似乎能带来良好的早期疗效。如果患者过于年轻且活动量大，无法遵循全肘关节置换术后推荐的限制措施，对于关节面严重受损的肘部骨折可考虑行肱骨远端半关节置换术。仍需取得进展以降低与肱骨远端骨折治疗相关的总体并发症发生率。
