| 微型钢板联合克氏针内固定治疗肱骨远端Dubberley 2B、3B型骨折的疗效分析 |
| Clinical efficacy of mini plate internal fixation through lateral elbow joint approach for Dubberley type 2B and 3B distal humeral coronal fractures |
| 投稿时间：2025-03-05 |
| DOI：10.3969/j.issn.1672-5972.2026.01.010 |
| 中文关键词: 肱骨远端 冠状面骨折 内固定 Dubberley分型 |
| 英文关键词:Distal humerus Coronal fractures Internal fixation Dubberley classification |
| 基金项目:荆门市重点科技计划项目（2024YFZD054） |
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| 摘要点击次数: 15 |
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| 中文摘要: |
| 目的 探讨采用外侧入路微型钢板联合克氏针内固定治疗Dubberley 2B、3B型肱骨远端冠状面骨折的临床疗效。方法 回顾性分析2019年3月至2024年3月京山仁和医院骨科和荆门市中心医院骨科收治的23例Dubberley 2B、3B型肱骨远端冠状面骨折患者资料。其中，男15例，女8例；年龄29～64岁；左侧13例，右侧10例。均为新鲜骨折，按Dubberley分型：2B型7例，3B型16例。采用外侧入路微型钢板联合克氏针内固定治疗。记录手术时间、术中出血量及并发症发生情况。术后3个月及末次随访时采用Mayo肘关节功能评分（MEPS）评定肘关节功能，同时采用疼痛视觉模拟评分（VAS）评估疼痛程度。结果 患者均获随访12～45个月［（18.2±4.1）个月］，手术时间为55～120 min［（74.1±4.5）min］，术中出血量为30～150 mL［（63.2±9.7）mL］。术后切口均一期愈合，骨折均获得骨性愈合，3例患者末次随访时有关节退变，2例有单纯关节周围骨赘形成，未见神经、血管损伤、螺钉切割、骨折不愈合、关节僵硬等并发症。术后3个月MEPS、VAS评分为（83.9±4.5）分、2.0（1.0，3.0）分，末次随访时MEPS、VAS评分为（92.6±2.7）分、1.0（0.0，1.0）分；均较术前的（42.6±3.2）分、5.0（4.0，7.0）分改善明显，差异均有统计学意义（P＜0.05）。末次随访时MEPS评分：优13例，良9例，中1例，优良率为95.6%（22/23）。结论 外侧入路微型钢板联合克氏针内固定治疗Dubberley 2B、3B型肱骨远端冠状面骨折，术中可充分显露，具有创伤小、内固定可靠的优势，肘关节功能恢复良好，可取得较好临床疗效。 |
| 英文摘要: |
| Objective To investigate the clinical efficacy of using a mini plate combined with Kirschner wire internal fixation via the lateral approach of the elbow joint for the treatment of Dubberley type 2B and 3B distal humeral coronal fractures.Methods A retrospective analysis was conducted on the data of 23 patients with Dubberley 2B and 3B type distal humeral coronal fractures admitted to the orthopedic department of Jingshan Renhe Hospital and Jingmen Central Hospital from March 2019 to March 2024. There were 15 males and 8 females; age ranged from 29 to 64 years old; 13 cases on the left and 10 cases on the right. All of them were fresh fractures, classified according to Dubberley's classification: 7 cases of 2B type and 16 cases of 3B type, namely humeral head and trochlear fractures, all of which were combined with distal posterior humeral fractures. A lateral approach was used for mini plate fixation, and during the operation, Kirschner wire fixation was added according to the size of the bone block. The surgical time, intraoperative blood loss, and incidence of complications were recorded. Three months after surgery and at the last follow-up, the Mayo elbow joint function score (MEPS) was used to assess elbow joint function, while the pain level was evaluated using the visual analog scale (VAS).Results All patients were followed up for 12-45 months [(18.2±4.1) months], with a surgical duration of 55-120 min [(74.1±4.5) min] and intraoperative blood loss of 30-150 mL [(63.2±9.7) mL]. All postoperative incisions healed in one stage, and all fractures achieved bony union. Three patients had joint degeneration at the last follow-up, and two had simple peri articular osteophyte formation. No complications such as nerve or vascular damage, screw cutting, fracture non union, or joint stiffness were observed. At 3 months after surgery, the MEPS and VAS scores were (83.9±4.5) points and 2.0 (1.0, 3.0) points, respectively. At the last follow-up, the MEPS and VAS scores were (92.6±2.7) points and 1.0 (0.0, 1.0) points. The improvement was significant compared to preoperative scores of (42.6±3.2) and 5.0 (4.0, 7.0), and the differences were statistically significant (P<0.05). At the last follow-up, the MEPS score was as follows: 13 cases were excellent, 9 cases were good, and 1 case was moderate, with an excellent and good rate of 95.6% (22/23).Conclusion The treatment of Dubberley 2B and 3B type distal humeral coronal fractures with lateral approach of elbow joint mini steel plate combined with Kirschner wire internal fixation can fully expose during surgery, has the advantages of minimal trauma and reliable internal fixation, and good recovery of elbow joint function, achieving good clinical efficacy. |
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