CAJ | 학술논문

目的：探讨肱骨小头骨折治疗方法及疗效。方法：1992年8月～2000年7月收治肱骨小头骨折25例，Mehdian Ⅰ型16例，Ⅱ型4例，Ⅲ型2例，Ⅳ型3例。其中，Ⅱ型4例、Ⅲ型1例行骨折碎片切除，其余20例行切开复位、内固定(AO中空松质骨螺钉加压固定9例，BIOFIX可吸收螺钉固定11例)，术后24～48小时即行肘关节功能锻炼。对所有病例均行X线及肘关节功能随访，随访8～96个月(平均22个月)。结果：骨折碎片切除组5例，4例Ⅱ型骨折肘关节功能均良好，屈130～150°，伸0～20°；1例Ⅲ型骨折功能稍差，肘关节屈120°，伸30°，劳累后偶有酸胀痛。内固定组骨愈合时间为6～9周(平均7周)。肘关节功能恢复良好，屈120～150°，伸0～40°，前臂旋转功能基本正常，无疼痛及骨片缺血坏死等并发症。1例Ⅲ型骨折行切开复位内固定术后肘关节继发骨化性肌炎，僵直于功能位。另1例Ⅳ型骨折肘关节功能恢复较差，屈100°，伸60°。结论：解剖复位、牢固固定、患肘早期活动是肱骨小头骨折功能恢复良好的前提。对于Ⅱ型骨折的软骨片及Ⅲ型粉碎骨折的小碎片难以内固定者，宜行手术切除，早期功能锻炼。
목적：탐토굉골소두골절치료방법급료효。방법：1992년8월～2000년7월수치굉골소두골절25례，Mehdian Ⅰ형16례，Ⅱ형4례，Ⅲ형2례，Ⅳ형3례。기중，Ⅱ형4례、Ⅲ형1례행골절쇄편절제，기여20례행절개복위、내고정(AO중공송질골라정가압고정9례，BIOFIX가흡수라정고정11례)，술후24～48소시즉행주관절공능단련。대소유병례균행X선급주관절공능수방，수방8～96개월(평균22개월)。결과：골절쇄편절제조5례，4례Ⅱ형골절주관절공능균량호，굴130～150°，신0～20°；1례Ⅲ형골절공능초차，주관절굴120°，신30°，로루후우유산창통。내고정조골유합시간위6～9주(평균7주)。주관절공능회복량호，굴120～150°，신0～40°，전비선전공능기본정상，무동통급골편결혈배사등병발증。1례Ⅲ형골절행절개복위내고정술후주관절계발골화성기염，강직우공능위。령1례Ⅳ형골절주관절공능회복교차，굴100°，신60°。결론：해부복위、뢰고고정、환주조기활동시굉골소두골절공능회복량호적전제。대우Ⅱ형골절적연골편급Ⅲ형분쇄골절적소쇄편난이내고정자，의행수술절제，조기공능단련。
Objective：To elucidate the ways and effect of treatment on capitellar fractures.Methods:Twenty-five patients with capitellar fractures were treated from August 1992 to July 2000(type I or Hahn-Steinthal fracture 16,type Ⅱ or Kocher-Lorenz fracture 4,type Ⅲ 2,type Ⅳ 3).Five patients(type Ⅱ 4,type Ⅲ 1)were managed with surgical resection of small fragments.Twenty patients were treated with open reduction,internal fixation and early motion of the elbow.The average duration of follow-up was twenty-two months(range,8 to 96 months).Results:The fracture united at an average of seven weeks(range,6 to 9 weeks).Flexion of the elbow in twenty-three patients was from 130～150°，extension 0～40°,protation and supination of the forearm normal.Conclusion:The principles of management of capitellar fractures are similar to any other intra-articular fracture.Accurate anatomic reduction,rigid internal fixation,and early mobilization of the elbow are prerequisites for a good functional result.Small fragments with minimal subchondral bone,not amenable to rigid internal fixation,are best treated by surgical resection.