Zalavras Charalampos G, Papasoulis Efthymios
Keck School of Medicine, University of Southern California, LAC+USC Medical Center, 1200 N State St, GNH 3900, Los Angeles, CA, 90033, USA.
Int Orthop. 2018 Nov;42(11):2653-2662. doi: 10.1007/s00264-017-3719-4. Epub 2018 Feb 5.
Intra-articular fractures of the distal humerus are complex injuries that can considerably limit elbow function if not treated appropriately. Surgical management is indicated for most intra-articular distal humerus fractures with the goal of restoring elbow range of motion and function. Open reduction and internal fixation (ORIF) with plates and screws has been the preferred surgical option. Double plating is recommended for bicolumnar fractures and plates can be applied either parallel or orthogonal to each other. Surgical approach for ORIF of the distal humerus can be performed through an olecranon osteotomy, but other approaches that preserve the olecranon are also in use, such as the triceps-reflecting, triceps-splitting, paratricipital, and triceps-reflecting anconeus pedicle approach. The ulnar nerve is identified during the approach, followed by either in situ decompression or anterior transposition. Elbow arthroplasty has also emerged as a viable alternative to ORIF for fixation of these fractures in elderly patients with poor bone quality.
肱骨远端关节内骨折是复杂的损伤，如果治疗不当会严重限制肘关节功能。大多数肱骨远端关节内骨折都需要手术治疗，目的是恢复肘关节的活动范围和功能。使用钢板和螺钉进行切开复位内固定（ORIF）一直是首选的手术方式。双钢板固定适用于双柱骨折，钢板可相互平行或垂直放置。肱骨远端ORIF的手术入路可通过尺骨鹰嘴截骨进行，但也有其他保留尺骨鹰嘴的入路在使用，如肱三头肌翻转、肱三头肌劈开、肱三头肌旁和肱三头肌翻转肘肌蒂入路。在手术入路过程中识别尺神经，随后进行原位减压或前移。对于骨质较差的老年患者，肘关节置换术也已成为ORIF治疗这些骨折的一种可行替代方案。
