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肱骨小头骨折的手术治疗

The Operative Management of Capitellum Fractures.

作者信息

Majeed Malik, Thahir Azeem, Krkovic Matjia

机构信息

School of Clinical Medicine, University of Cambridge, Cambridge, GBR.

Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR.

出版信息

Cureus. 2024 Apr 29;16(4):e59326. doi: 10.7759/cureus.59326. eCollection 2024 Apr.

Abstract

Capitellum fractures represent fewer than 1% of elbow fractures. Most commonly, these fractures occur secondary to either axial loading with the elbow fully extended or direct impact to the lateral aspect of the elbow. Numerous classification systems exist, with many types and subtypes. Since capitellum fractures are uncommon and fracture type varies widely, there is a lack of consensus with regard to treatment recommendations. We present a case series of seven patients with capitellum fractures, who presented between January 2016 and August 2020 to Addenbrooke's Hospital (Cambridge, the United Kingdom). All patients were female, with an average age of 33 years. In each case, the affected elbow joint was immobilised using a backslab before open reduction and internal fixation (ORIF) was performed. Joint mobility was recorded both on the day of the injury and at clinic review postoperatively (first at two weeks and then at between four and eight weeks). The Oxford Elbow Score (OES) was measured retrospectively, relating to (1) before the injury and (2) six months after fracture reduction. ORIF was associated with a near-full return of pronation and supination by eight weeks, with flexion-extension also improving significantly. The Oxford Elbow Score at six months reached 82.0% of pre-injury scores. Overall, our results suggest that ORIF is a well-tolerated and effective treatment strategy for capitellum fractures. Future studies with a greater sample size are required to assess the outcomes across a longer period, to determine whether outcomes are maintained and continue to improve.

摘要

肱骨小头骨折占肘部骨折的比例不到1%。最常见的情况是,这些骨折继发于肘部完全伸展时的轴向负荷或肘部外侧受到直接撞击。现有的分类系统众多,有许多类型和亚型。由于肱骨小头骨折并不常见且骨折类型差异很大,对于治疗建议缺乏共识。我们报告了一组七例肱骨小头骨折患者的病例系列,这些患者于2016年1月至2020年8月期间就诊于阿登布鲁克医院(英国剑桥)。所有患者均为女性,平均年龄33岁。在每例病例中,在进行切开复位内固定(ORIF)之前,先用背侧板固定患侧肘关节。记录受伤当天以及术后门诊复查时(最初在两周时,然后在四周至八周之间)的关节活动度。回顾性测量牛津肘关节评分(OES),涉及(1)受伤前和(2)骨折复位后六个月。切开复位内固定术后八周时,旋前和旋后功能几乎完全恢复,屈伸功能也显著改善。六个月时的牛津肘关节评分达到受伤前评分的82.0%。总体而言,我们的结果表明,切开复位内固定是治疗肱骨小头骨折的一种耐受性良好且有效的治疗策略。需要开展更大样本量的未来研究,以评估更长时间段内的结果,确定结果是否得以维持并持续改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e560/11137435/1a4cefca808a/cureus-0016-00000059326-i01.jpg

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