探讨肘后路结合多种固定在肱骨远端冠状面骨折中的临床应用。

自2005年1月至2018年1月，本科共收治18例肱骨远端冠状面骨折患者，其中女15例、男3例，平均年龄50岁。摔倒10例，机动车交通事故4例，运动损伤1例，高处掉落3例。手术均顺利完成，采用肘后侧入路切开复位内固定，术中使用多种内固定方式固定骨折端。术后药物抗炎、止痛、预防固化性肌炎，携带肘关节支具保护6周，循序康复锻炼。

手术时间60~100 min，平均75 min。术后切口均I期愈合，均获骨性愈合，愈合平均时间6个月。本组患者上肢功能评分表（disability of arm shoulder and hand，DASH）评分20分。无骨不连和神经损伤病例，有2例创伤性关节炎（1例Broberg-Morrey1级，另1例Broberg-Morrey 2级，均行保守治疗），1例异位骨化（Brooker 1级，无症状）。

肘后路结合多种固定治疗肱骨远端冠状面骨折的方法，具有骨折显露充分、固定牢固、安全有效、易处理合并损伤等优点，临床疗效好。

The coronal fracture of distal humerus is an articular surface fracture involving capitellum humeri and (or) trochlea humeri. The distal humerus fracture accounts for 2%-6% of humeral fractures, and approximately 30% of elbow joint fractures. Coronal fracture of distal humerus is very rare clinically, accounting for 6% of distal humerus fracture and 1% of elbow fracture. Most of them occurred in young men with high energy trauma and old women with low energy trauma and osteoporosis. This injury is more common in women over 60 years old, which may be related to the larger carrying angle and postmenopausal osteoporosis. The distal humerus has less soft tissue attachment, and the coronal fracture caused by shear force is easy to displace. Thus, open reduction and internal fixation are recommended.ObjectiveTo explore the clinical application of posterior approach combined with multiple fixations in the treatment of distal humeral coronal fracture.

From 2005 to 2018, 18 cases of distal humeral coronal fractures received treatment in our department, including 15 females and 3 males, and the mean age was 50. There were 10 falls, 4 motor vehicle accidents, 1 sports injury and 3 high falls. All patients were treated with open reduction and internal fixation through posterior approach, and various internal fixation methods were used to fix the fractures. All the operations were successfully completed. After operation, anti-inflammatory and analgesic drugs were used to prevent heterotopic ossification. Rehabilitation exercises were gradually carried out.

The operation time was 60-100 minutes, with an average of 75 minutes. All the incisions healed primarily. All patients had bone union, and the mean time of bone union was 6 months. The mean DASH score of this group was 20. There were no cases of nonunion or nerve injury. Two cases had traumatic arthritis (1 case of Broberg and Morrey grade I and 1 case of Broberg and Morrey grade II wereconservatively treated) , and 1 case had heterotopic ossification (Brooker classification grade 1, asymptomatic) .

The treatment of distal humeral coronal fracture through posterior approach combined with various fixation methods has the advantages of adequate exposure, rigid fixation, safety and effectiveness, easy handling of combined injuries, etc., and thus has good clinical effect.