肱骨远端冠状面剪切骨折的诊疗进展_West China Medical Journal

Authors：

 赵思淳 , 徐龙 ,  黄富国

四川大学华西医院骨科（成都 610041）;

Corresponding author：

黄富国, Email: huang-f-g@163.com

Keywords：

肱骨远端; 冠状面剪切骨折; 肱骨小头; 滑车; 关节内骨折

DOI：

10.7507/1002-0179.20150113

Video：

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肱骨远端冠状面剪切骨折较少见，多累及肱骨小头和滑车，且常伴有肘关节骨和软组织韧带损伤，其诊断和治疗目前尚存在诸多争议。现根据国内外文献，就肱骨远端冠状面剪切骨折的发病机制、分型、诊断、治疗进展、术后管理及并发症作一综述。

Citation： 赵思淳, 徐龙, 黄富国. 肱骨远端冠状面剪切骨折的诊疗进展. West China Medical Journal, 2015, 30(2): 380-384. doi: 10.7507/1002-0179.20150113 Copy

1.	Bryan RS, Morrey BF. The elbow and its disorders[M]. Philadlphia:Saunders, 1985:325-333.
2.	Guitton TG, Doornberg JN, Raaymakers EL, et al. Fractures of the capitellum and trochlea[J]. J Bone Joint Surg, 2009, 91A(2):390-397.
3.	Dubberley JH, Faber KJ, Macdermid JC, et al. Outcome after open reduction and internal fixation of capitellar and trochlear fractures[J]. J Bone Joint Surg Am, 2006, 88A(1):46-54.
4.	Ring D, Jupiter JB, Gulotta L. Articular fracture of the distal part of the humerus[J]. J Bone Joint Surg Am, 2003, 85-A(2):232-238.
5.	Watts AC, Morris A, Robinson CM. Fractures of the distal humeral articular surface[J]. J Bone Joint Surg Am, 2007, 89B(4):510-515.
6.	Jupiter JB, Neff U, Regazzoni P, et al. Unicondylar fractures of the distal humerus:an operative approach[J]. J Orthop Trauma, 1988, 2(2):102-109.
7.	O'driscoll SW, Morrey BF, Korinek S, et al. Elbow subluxation and dislocation. A spectrum of instability[J]. Clin Orthop Relat Res, 1992(280):186-197.
8.	Mckee MD, Juplter JB, Bamberger HB. Coronal shear fracture of the distal end of the humerus[J]. J Bone Joint Surg Am, 1996, 78(1):49-54.
9.	Chamseddine A, Hamdan H, Obeid B, et al. Articular coronal fractures of the distal humerus[J]. Chir Main, 2009, 28(6):352-362.
10.	Ashwood N, Verma M, Hamlet M, et al. Transarticular shear fractures of the distal humerus[J]. J Shoulder Elbow Surg, 2010, 19(1):46-52.
11.	Ruchelsman DE, Tejwani NC, Kwon YW, et al. Open reduction and internal fixation of capitellar fractures with headless screws[J]. J Bone Joint Surg Am, 2008, 90A(6):1321-1329.
12.	Guitton TG, Doornberg JN, Raaymakers EL, et al. Fractures of the capitellum and trochlea[J]. J Bone Joint Surg Am, 2009, 91A(2):390-397.
13.	张涛, 马宝通, 庞桂根, 等. 肱骨小头骨折的手术疗效分析[J]. 中国矫形外科杂志, 2012, 20(18):1653-1656.
14.	Goodman HJ, Choueka J. Complex coronal shear fractures of the distal humerus[J]. Bull Hosp Jt Dis, 2005, 62(3/4):85-89.
15.	Singh AP, Singh AP, Vaishya R, et al. Fractures of capitellum: a review of 14 cases treated by open reduction and internal fixation with Herbert screws[J]. Int Orthop, 2010, 34(6):897-901.
16.	Mighell M, Virani NA, Shannon R, et al. Large coronal shear fractures of the capitellum and trochlea treated with headless compression screws[J]. J Shoulder Elbow Surg, 2010, 19(1):38-45.
17.	Sano S, Rokkaku T, Saito S, et al. Herbert screw fixation of capitellar fractures[J]. J Shoulder Elbow Surg, 2005, 14(3):307-311.
18.	Mahirogullari M, Kiral A, Solakoglu C, et al. Treatment of fractures of the humeral capitellum using herbert screws[J]. J Hand Surg Br, 2006, 31B(3):320-325.
19.	Mighell MA, Harkins D, Klein D, et al. Technique for internal fixation of capitellum and lateral trochlea fractures[J]. J Orthop Trauma, 2006, 20(10):699-704.
20.	Giannicola G, Sacchetti FM, Greco A, et al. Open reduction and internal fixation combined with hinged elbow fixator in capitellum and trochlea fractures[J]. Acta Orthop, 2010, 81(2):230-235.
21.	Dushuttle RP, Coyle MP, Zawadsky JP, et al. Fractures of the capitellum[J]. J Trauma, 1985, 25(4):317-321.
22.	Kuriyama K, Kawanishi Y, Yamamoto K. Arthroscopic-assisted reduction and percutaneous fixation for coronal shear fractures of the distal humerus:report of two cases[J]. J Hand Surg, 2010, 35A(9):1506-1509.
23.	Feldman MD. Arthroscopic excision of type Ⅱ capitellar fractures[J]. Arthroscopy, 1997, 13(6):743-748.
24.	Mitani M, Nabeshima Y, Ozaki A, et al. Arthroscopic reduction and percutaneous cannulated screw fixation of a capitellar fracture of the humerus:a case report[J]. J Shoulder Elbow Surg, 2009, 18(2):e6-e9.
25.	Holt MS, Savoie FI, Field LD, et al. Arthroscopic management of elbow trauma[J]. Hand Clin, 2004, 20(4):485-495.
26.	Patton MS, Johnstone AJ. The role of total elbow arthroplasty in complex distal humeral fractures[J]. Eur J Trauma Surg, 2008, 34(2):99-104.
27.	Athwal GS, Goetz TJ, Pollock J. Prosthetic replacement for distal humerus fractures[J]. Orthop Clin North Am, 2008, 39(2):201.
28.	DeLuise A,Voloshin J. Current management of distal humerus fractures[J]. Curr Opin Orthop, 2006, 4:340-347.
29.	Imatani J, Morito Y, Hashizume H, et al. Internal fixation for coronal shear fracture of the distal end of the humerus by the anterolateral approach[J]. J Shoulder Elbow Surg, 2001, 10(6):554-556.
30.	Malki AA, Salloom FM, Wong-Chung J, et al. Cannulated screw fixation of fractured capitellum:surgical technique through a limited approach[J]. Injury, 2000, 31(3):204-206.
31.	李文基, 梁小军, 张霖. 肘前入路螺钉固定治疗肱骨小头骨折[J]. 中华骨科杂志, 2006, 26(1):17-20.
32.	肖裕华, 李绍琴, 李建飞, 等. 成人肱骨小头冠状面骨折的手术治疗[J]. 中国矫形外科杂志, 2006, 14(24):1850-1852.
33.	Poynton AR, Kelly IP, O'rourke SK. Fractures of the capitellum: a comparison of two fixation methods[J]. Injury, 1998, 29(5):341-343.
34.	Koslowsky TC, Mader K, Gausepohl T, et al. Reconstruction of Mason type-Ⅲ and type-Ⅳ radial head fractures with a new fixation device-23 patients followed 1-4 years[J]. Acta Orthop, 2007, 78(1):151-156.
35.	Koslowsky TC, Mader K, Kirchner S, et al. Treatment of medial malleolar fractures using fine threaded K-wires. A new operative technique[J]. J Trauma, 2007, 62(1):258-261.
36.	Heck S, Zilleken C, Pennig D, et al. Reconstruction of radial capitellar fractures using fine-threaded implants (FFS)[J]. Injury, 2012, 43(2):164-168.
37.	Elkowitz SJ, Polatsch DB, Egol KA, et al. Capitellum fractures: a biomechanical evaluation of three fixation methods[J]. J Orthop Trauma, 2002, 16(7):503-506.
38.	Elkowitz SJ, Kubiak EN, Polatsch D, et al. Comparison of two headless screw designs for fixation of capitellum fractures[J]. Bull Hosp Jt Dis, 2003, 61(3/4):123-126.
39.	Sen MK, Sama N, Helfet DL. Open reduction and internal fixation of coronal fractures of the capitellum[J]. J Hand Surg, 2007, 32A(9):1462-1465.
40.	Koslowsky TC, Zilleken C, Dargel JA, et al. Reconstruction of a bryan and morrey typeⅠ capitellar fracture in a sawbone model with four different fixation devices:an experimental study[J]. Injury, 2012, 43(3):381-385.
41.	刁振鸿, 马向阳, 龚江峰. 可吸收螺钉内固定治疗成人肱骨小头骨折[J]. 临床骨科杂志, 2008, 11(2):159-160.
42.	Sabo MT, Fay K, Mcdonald CP, et al. Effect of coronal shear fractures of the distal humerus on elbow kinematics and stability[J]. J Shoulder Elbow Surg, 2010, 19(5):670-680.
43.	Takeda H, Watarai K, Matsushita T, et al. A surgical treatment for unstable osteochondritis dissecans lesions of the humeral capitellum in adolescent baseball players[J]. Am J Sports Med, 2002, 30(5):713-717.

1. Bryan RS, Morrey BF. The elbow and its disorders[M]. Philadlphia:Saunders, 1985:325-333.
2. Guitton TG, Doornberg JN, Raaymakers EL, et al. Fractures of the capitellum and trochlea[J]. J Bone Joint Surg, 2009, 91A(2):390-397.
3. Dubberley JH, Faber KJ, Macdermid JC, et al. Outcome after open reduction and internal fixation of capitellar and trochlear fractures[J]. J Bone Joint Surg Am, 2006, 88A(1):46-54.
4. Ring D, Jupiter JB, Gulotta L. Articular fracture of the distal part of the humerus[J]. J Bone Joint Surg Am, 2003, 85-A(2):232-238.
5. Watts AC, Morris A, Robinson CM. Fractures of the distal humeral articular surface[J]. J Bone Joint Surg Am, 2007, 89B(4):510-515.
6. Jupiter JB, Neff U, Regazzoni P, et al. Unicondylar fractures of the distal humerus:an operative approach[J]. J Orthop Trauma, 1988, 2(2):102-109.
7. O'driscoll SW, Morrey BF, Korinek S, et al. Elbow subluxation and dislocation. A spectrum of instability[J]. Clin Orthop Relat Res, 1992(280):186-197.
8. Mckee MD, Juplter JB, Bamberger HB. Coronal shear fracture of the distal end of the humerus[J]. J Bone Joint Surg Am, 1996, 78(1):49-54.
9. Chamseddine A, Hamdan H, Obeid B, et al. Articular coronal fractures of the distal humerus[J]. Chir Main, 2009, 28(6):352-362.
10. Ashwood N, Verma M, Hamlet M, et al. Transarticular shear fractures of the distal humerus[J]. J Shoulder Elbow Surg, 2010, 19(1):46-52.
11. Ruchelsman DE, Tejwani NC, Kwon YW, et al. Open reduction and internal fixation of capitellar fractures with headless screws[J]. J Bone Joint Surg Am, 2008, 90A(6):1321-1329.
12. Guitton TG, Doornberg JN, Raaymakers EL, et al. Fractures of the capitellum and trochlea[J]. J Bone Joint Surg Am, 2009, 91A(2):390-397.
13. 张涛, 马宝通, 庞桂根, 等. 肱骨小头骨折的手术疗效分析[J]. 中国矫形外科杂志, 2012, 20(18):1653-1656.
14. Goodman HJ, Choueka J. Complex coronal shear fractures of the distal humerus[J]. Bull Hosp Jt Dis, 2005, 62(3/4):85-89.
15. Singh AP, Singh AP, Vaishya R, et al. Fractures of capitellum: a review of 14 cases treated by open reduction and internal fixation with Herbert screws[J]. Int Orthop, 2010, 34(6):897-901.
16. Mighell M, Virani NA, Shannon R, et al. Large coronal shear fractures of the capitellum and trochlea treated with headless compression screws[J]. J Shoulder Elbow Surg, 2010, 19(1):38-45.
17. Sano S, Rokkaku T, Saito S, et al. Herbert screw fixation of capitellar fractures[J]. J Shoulder Elbow Surg, 2005, 14(3):307-311.
18. Mahirogullari M, Kiral A, Solakoglu C, et al. Treatment of fractures of the humeral capitellum using herbert screws[J]. J Hand Surg Br, 2006, 31B(3):320-325.
19. Mighell MA, Harkins D, Klein D, et al. Technique for internal fixation of capitellum and lateral trochlea fractures[J]. J Orthop Trauma, 2006, 20(10):699-704.
20. Giannicola G, Sacchetti FM, Greco A, et al. Open reduction and internal fixation combined with hinged elbow fixator in capitellum and trochlea fractures[J]. Acta Orthop, 2010, 81(2):230-235.
21. Dushuttle RP, Coyle MP, Zawadsky JP, et al. Fractures of the capitellum[J]. J Trauma, 1985, 25(4):317-321.
22. Kuriyama K, Kawanishi Y, Yamamoto K. Arthroscopic-assisted reduction and percutaneous fixation for coronal shear fractures of the distal humerus:report of two cases[J]. J Hand Surg, 2010, 35A(9):1506-1509.
23. Feldman MD. Arthroscopic excision of type Ⅱ capitellar fractures[J]. Arthroscopy, 1997, 13(6):743-748.
24. Mitani M, Nabeshima Y, Ozaki A, et al. Arthroscopic reduction and percutaneous cannulated screw fixation of a capitellar fracture of the humerus:a case report[J]. J Shoulder Elbow Surg, 2009, 18(2):e6-e9.
25. Holt MS, Savoie FI, Field LD, et al. Arthroscopic management of elbow trauma[J]. Hand Clin, 2004, 20(4):485-495.
26. Patton MS, Johnstone AJ. The role of total elbow arthroplasty in complex distal humeral fractures[J]. Eur J Trauma Surg, 2008, 34(2):99-104.
27. Athwal GS, Goetz TJ, Pollock J. Prosthetic replacement for distal humerus fractures[J]. Orthop Clin North Am, 2008, 39(2):201.
28. DeLuise A,Voloshin J. Current management of distal humerus fractures[J]. Curr Opin Orthop, 2006, 4:340-347.
29. Imatani J, Morito Y, Hashizume H, et al. Internal fixation for coronal shear fracture of the distal end of the humerus by the anterolateral approach[J]. J Shoulder Elbow Surg, 2001, 10(6):554-556.
30. Malki AA, Salloom FM, Wong-Chung J, et al. Cannulated screw fixation of fractured capitellum:surgical technique through a limited approach[J]. Injury, 2000, 31(3):204-206.
31. 李文基, 梁小军, 张霖. 肘前入路螺钉固定治疗肱骨小头骨折[J]. 中华骨科杂志, 2006, 26(1):17-20.
32. 肖裕华, 李绍琴, 李建飞, 等. 成人肱骨小头冠状面骨折的手术治疗[J]. 中国矫形外科杂志, 2006, 14(24):1850-1852.
33. Poynton AR, Kelly IP, O'rourke SK. Fractures of the capitellum: a comparison of two fixation methods[J]. Injury, 1998, 29(5):341-343.
34. Koslowsky TC, Mader K, Gausepohl T, et al. Reconstruction of Mason type-Ⅲ and type-Ⅳ radial head fractures with a new fixation device-23 patients followed 1-4 years[J]. Acta Orthop, 2007, 78(1):151-156.
35. Koslowsky TC, Mader K, Kirchner S, et al. Treatment of medial malleolar fractures using fine threaded K-wires. A new operative technique[J]. J Trauma, 2007, 62(1):258-261.
36. Heck S, Zilleken C, Pennig D, et al. Reconstruction of radial capitellar fractures using fine-threaded implants (FFS)[J]. Injury, 2012, 43(2):164-168.
37. Elkowitz SJ, Polatsch DB, Egol KA, et al. Capitellum fractures: a biomechanical evaluation of three fixation methods[J]. J Orthop Trauma, 2002, 16(7):503-506.
38. Elkowitz SJ, Kubiak EN, Polatsch D, et al. Comparison of two headless screw designs for fixation of capitellum fractures[J]. Bull Hosp Jt Dis, 2003, 61(3/4):123-126.
39. Sen MK, Sama N, Helfet DL. Open reduction and internal fixation of coronal fractures of the capitellum[J]. J Hand Surg, 2007, 32A(9):1462-1465.
40. Koslowsky TC, Zilleken C, Dargel JA, et al. Reconstruction of a bryan and morrey typeⅠ capitellar fracture in a sawbone model with four different fixation devices:an experimental study[J]. Injury, 2012, 43(3):381-385.
41. 刁振鸿, 马向阳, 龚江峰. 可吸收螺钉内固定治疗成人肱骨小头骨折[J]. 临床骨科杂志, 2008, 11(2):159-160.
42. Sabo MT, Fay K, Mcdonald CP, et al. Effect of coronal shear fractures of the distal humerus on elbow kinematics and stability[J]. J Shoulder Elbow Surg, 2010, 19(5):670-680.
43. Takeda H, Watarai K, Matsushita T, et al. A surgical treatment for unstable osteochondritis dissecans lesions of the humeral capitellum in adolescent baseball players[J]. Am J Sports Med, 2002, 30(5):713-717.

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肱骨远端冠状面剪切骨折的诊疗进展

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