Tanrıverdi Bülent, Kural Cemal, Altun Süleyman
Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji Kliniği, 34147 Bakırköy İstanbul, Türkiye.
Jt Dis Relat Surg. 2020;31(2):291-297. doi: 10.5606/ehc.2020.72821. Epub 2020 Jun 18.
This study aims to present the results of 21 patients with capitellum fractures treated with open reduction and headless screws by a single experienced surgeon.
Twenty-one patients (13 males, 8 females; mean age 39 years; range, 18 to 63 years) who were admitted to our clinic between June 2011 and January 2018 with the diagnosis of capitellum fracture and followed-up for a mean period of 45 months (range, 12 to 90 months) were included in this retrospective study. The fractures were fixed with headless cannulated screws by a single surgeon.
The mean range of motion was 102° (range, 65° to 140°) during flexion-extension and 165° (range, 130° to 180°) during supination-pronation. The mean preoperative visual analog scale (VAS) score was 8.5 (range, 6 to 10), whereas the mean postoperative VAS score was 2.2 (range, 0 to 6). According to the Mayo Elbow Performance score, nine patients were evaluated as excellent, six patients as good, four patients as fair, and two as poor. The mean Quick-Disabilities of the Arm, Shoulder and Hand score was 25.1 (range, 4 to 57). Avascular necrosis developed in three patients (14%) and heterotopic ossification was detected in one patient (4%).
Capitellum fractures are difficult to diagnose and treat, and good results can only be achieved by an accurate diagnosis, careful surgical technique, and stable fixation. Larger and more comprehensive studies are required to establish a generalization and more accurate inferences on this limitedly studied subject.
本研究旨在呈现由一位经验丰富的外科医生采用切开复位和无头螺钉治疗的21例肱骨小头骨折患者的结果。
纳入2011年6月至2018年1月间因肱骨小头骨折入院并接受平均45个月（范围12至90个月）随访的21例患者（13例男性，8例女性；平均年龄39岁；范围18至63岁）进行这项回顾性研究。骨折均由同一位外科医生使用无头空心螺钉固定。
屈伸活动度平均为102°（范围65°至140°），旋前旋后活动度平均为165°（范围130°至180°）。术前视觉模拟量表（VAS）评分平均为8.5（范围6至10），而术后VAS评分平均为2.2（范围0至6）。根据梅奥肘关节功能评分，9例患者评定为优，6例为良，4例为中，2例为差。上肢、肩部和手部快速残疾评定量表平均评分为25.1（范围4至57）。3例患者（14%）发生缺血性坏死，1例患者（4%）检测到异位骨化。
肱骨小头骨折诊断和治疗困难，只有通过准确诊断、精细的手术技术和稳定固定才能取得良好效果。需要开展更大规模、更全面的研究，以便对这个研究有限的课题进行归纳总结并得出更准确的推论。
