Department of Orthopedics and Traumatology, Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China.
Department of Orthopaedics, University of California, San Francisco, CA, USA.
J Shoulder Elbow Surg. 2019 May;28(5):931-938. doi: 10.1016/j.jse.2018.09.004. Epub 2018 Dec 28.
This study aimed to evaluate the safety and efficacy of the fixation of Dubberley type B capitellar and trochlear fractures using dorsolateral anatomic plates with support of the distal humerus (DAPSDHs).
Fifteen patients with Dubberley type B capitellar and trochlear fractures (two type 1B, five type 2B, and eight type 3B) were treated through the extended lateral approach, and fixation was achieved with DAPSDHs. Radiographic evaluation was performed, and range of motion of the elbow and forearm was recorded. Functional outcomes were assessed using the Mayo Elbow Performance Score and Disabilities of the Arm, Shoulder and Hand score.
The mean follow-up period was 32.5 months (range, 24-54 months). Fracture union was achieved in all cases. At the final follow-up, range of motion was as follows: flexion, 123.7° ± 8.1° (range, 110°-135°); lack of extension, 11.0° ± 7.1° (range, 5°-30°); pronation, 81.7° ± 5.6° (range, 70°-90°); and supination, 78.7° ± 5.2° (range, 70°-85°). At the final follow-up, the mean Disabilities of the Arm, Shoulder and Hand score was 11.9 ± 4.0 (range, 4.2-20.8) and the mean Mayo Elbow Performance Score was 89.0 ± 7.1 (range, 70-95). The outcome was rated as excellent in 12 patients (80.0%), good in 2 (13.3%), and fair in 1 (6.7%). Avascular necrosis of the capitellum developed in 1 patient. One patient had implant irritation. Heterotopic ossification developed in 1 patient. Ten patients returned to their previous activity levels.
Capitellar and trochlear fractures with posterior comminution are safely and effectively treated through the extended lateral approach using DAPSDHs, resulting in good radiographic and functional outcomes.
本研究旨在评估使用支持肱骨远端的背外侧解剖钢板（DAPSDH）固定 Dubberley 型 B 型肱骨小头和滑车骨折的安全性和有效性。
通过扩展的外侧入路治疗 15 例 Dubberley 型 B 型肱骨小头和滑车骨折（2 型 1B，5 型 2B，8 型 3B），并使用 DAPSDH 固定。进行影像学评估，并记录肘部和前臂的活动范围。使用 Mayo 肘部功能评分和上肢残疾评分评估功能结果。
平均随访时间为 32.5 个月（范围 24-54 个月）。所有病例均达到骨折愈合。在最后一次随访时，活动范围如下：屈曲 123.7°±8.1°（范围 110°-135°）；缺乏伸展 11.0°±7.1°（范围 5°-30°）；旋前 81.7°±5.6°（范围 70°-90°）；旋后 78.7°±5.2°（范围 70°-85°）。在最后一次随访时，上肢残疾评分平均为 11.9±4.0（范围 4.2-20.8），Mayo 肘部功能评分平均为 89.0±7.1（范围 70-95）。结果评定为优 12 例（80.0%），良 2 例（13.3%），可 1 例（6.7%）。1 例发生肱骨小头缺血性坏死。1 例患者有植入物刺激。1 例发生异位骨化。10 例患者恢复到以前的活动水平。
通过使用 DAPSDH 的扩展外侧入路，可安全有效地治疗伴有后粉碎的肱骨小头和滑车骨折，获得良好的影像学和功能结果。
