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1、DistalHumeralFracturesinAdults成人中的肱骨远端骨折AaronNauth,MichaelD.McKee,BillRistevski,JeremyHallandEmilH.SchemitschJBoneJointSurgAm.2011;93:686-700.Distalhumeralfracturesinadultsarerelativelyuncommoninjuriesthatrequireoperativeinterventioninthemajorityofcases.Dualplatefixation,withplacementofas
2、eparatestrongplateoneachcolumnandorientationoftheplateseitherat90_or180_toeachother,isindicatedforalladultfracturesinvolvingbothcolumnsofthedistalpartofthehumerus.Acutetotalelbowarthroplastyisthepreferredtreatmentforelderlypatientswithadisplaced,comminuted,intraarticulardistalhumeralfract
3、urethatisnotamenabletostableinternalfixation.Displacedcoronalshearfracturesofthedistalhumeralarticularsurfacerequireoperativefixation,mosttypicallyviaalateralapproach.肱骨远端骨折在成人损伤中并不常见，大部分病例需要手术干预。双钢板固定适用于所有肱骨远端涉及双柱的成人骨折，这一技术要求在每个柱上各置入一枚坚强的钢板，两枚钢板之间的方向为90度或180度。在难复性移位粉碎的肱骨远端骨折中，内固定不能使骨折获得稳
4、定时，对于老年患者可给予急症全肘关节置换治疗。肱骨远端关节面的冠状面剪力移位骨折需要内固定手术治疗，多经外侧入路实施手术。Distalhumeralfracturesinadultsarecomplexandtechnicallydemandinginjuriestomanage.Operativeinterventionisindicatedinmostcasesandisoftencomplicatedbydifficultexposure,osteoporoticbone,andcomminutioninthemetaphysealand/orarticularre
5、gion.Thereiscontroversyregardinganumberofissuespertainingtothemanagementofdistalhumeralfractures,includingthecorrectoperativeapproach,fixationstrategies,theroleoftotalelbowarthroplasty,managementoftheulnarnerve,andindicationsforprophylaxisagainstheterotopicossification.Thisarticleprovides
6、anoverviewoftheseissuesandothersbyreviewingtheavailableevidenceintheliteratureondistalhumeralfracturesandprovidinggradedrecommendations.成人中的肱骨远端骨折的处理较为复杂，技术要求较高。大部分病例适于手术治疗，并发症的发生常由于手术暴露困难，骨质疏松以及干骺端或/和关节面粉碎等因素所致。肱骨远端骨折处理中的相关问题包括正确的选择手术入路，固定策略，全肘关节置换的意义，尺神经的处理以及实施异位骨化预防措施的指证等。本文通过回顾肱骨远端骨折的
7、相关文献，对上述问题进行分析总结并提出分级治疗意见。Epidemiology流行病学Distalhumeralfractureshaveanestimatedincidenceinadultsof5.7per100,000personsperyear1.Theseinjuriesoccurinabimodaldistribution,withanearlypeakinyoungmales,twelvetonineteenyearsofage,asaresultofhigh-energytrauma,andasecondpeak
