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中华肩肘外科电子杂志

中华肩肘外科电子杂志 ›› 2022, Vol. 10 ›› Issue (04) : 374 -378. doi: 10.3877/cma.j.issn.2095-5790.2022.04.015

综述

Dubberley B型肱骨远端冠状面骨折治疗的研究进展
盛世豪1, 周启荣1, 苏佳灿1,†()   
  1. 1. 200433　上海，海军军医大学第一附属医院长海医院创伤骨科
  • 收稿日期:2022-06-25 出版日期:2022-11-05
  • 通信作者: 苏佳灿
  • 基金资助:
    国家自然科学基金(81901426)

Research progress in the treatment of Dubberley type B coronal shear fractures of the distal humerus

Shihao Sheng1, Qirong Zhou1, Jiacan Su1()   

  • Received:2022-06-25 Published:2022-11-05
  • Corresponding author: Jiacan Su
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盛世豪, 周启荣, 苏佳灿. Dubberley B型肱骨远端冠状面骨折治疗的研究进展[J]. 中华肩肘外科电子杂志, 2022, 10(04): 374-378.

Shihao Sheng, Qirong Zhou, Jiacan Su. Research progress in the treatment of Dubberley type B coronal shear fractures of the distal humerus[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2022, 10(04): 374-378.

肱骨远端冠状面骨折是指涉及肱骨小头、滑车及后髁的肱骨远端关节内骨折。其发生率占所有肘部骨折的1%，占所有肱骨远端骨折的6%[1,2,3,4] 。80%以上的肱骨远端冠状面骨折发生在女性及老年患者中，因为老年女性更易患有肘关节外翻、反屈畸形和骨质疏松[5] 。一项Meta分析[6]研究发现Dubberley 3A型和3B型骨折的Mayo肘关节功能评估指数（Mayo elbow performance index,MEPI）有显著差异，与B型骨折患者相比，A型骨折患者的MEPI评分更高，验证了肱骨远端冠状面骨折中后髁粉碎对肘关节功能恢复的重要性，同时此类骨折患者有着更高的术后并发症及再手术率[1] ，其手术入路及内固定方式的选择对患者术后关节功能恢复至关重要。因此，本文就Dubberley B型肱骨远端冠状面骨折的解剖学、发生机制、分型、治疗等方面作一综述，以期使读者对Dubberley B型肱骨远端冠状面骨折有一个更加全面的认识，从而选择更合理的治疗方式。

图1 肱骨远端冠状面骨折的发生机制[2]　图A:肘关节伸直时沿桡骨向肱骨的间接冲击导致桡骨头对肱骨远端产生垂直剪切力；图B：肘关节向后外侧一过性脱位时伴随有桡骨头在肱骨小头后方的嵌塞，在肘关节自发复位的过程中桡骨头使肱骨小头分离
图2 改进的Dubberley分类系统中的4型骨折：在3型骨折基础上伴有多种矢状面和冠状面骨折线　图A：肘关节CT三维重建正位图像，可见肱骨小头、滑车上多个骨折小碎片；图B：肘关节CT三维重建侧位图像，可见后踝骨折
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