一例肱骨干中下段骨折合并肱骨远端复杂 粉碎性骨折报告并文献回顾

Case Report of a Mid-Lower Shaft Humerus Fracture Combined with Complex Comminuted Distal Humerus Fracture and Literature Review

摘要: 肱骨干中下段骨折合并肱骨远端复杂粉碎性骨折是临床上极为罕见的骨折类型，发病率极低，治疗难度较大。从解剖学角度看，肱骨干中下段毗邻重要的神经和血管结构，如桡神经紧贴肱骨干中下1/3段后外侧桡神经沟行走，发生骨折时骨折端不稳极易损伤桡神经，造成患者垂腕、垂指等严重功能障碍，而肱骨远端则具有复杂的解剖结构，由多个部位组成，如肱骨滑车、肱骨小头、内外侧髁等多个部分组成，是承担肘关节的屈伸和旋转功能的重要组成部分。复杂粉碎性骨折会破坏肱骨远端关节面的完整性，影响关节的稳定性和活动度，以及增加创伤性骨关节炎等并发症的发生风险。在临床治疗方面，肱骨干中下段骨折合并肱骨远端复杂粉碎性骨折面临诸多挑战，由于骨折部位的特殊性和骨折的复杂性，闭合复位困难，大多数需切开复位内固定，正确的手术入路能较好地显示骨折断端，有利于骨折的准确复位，内置物的钢板、螺钉可以达到最优排列分布，达到坚强固定。对这类复杂骨折的诊断和治疗要点，通过典型案例，结合相关文献资料进行探讨。

Abstract: The fracture of middle and lower humeral shaft combined with complex comminuted fracture of distal humerus is an extremely rare fracture type in clinic, with extremely low incidence and difficult treatment. From the anatomical point of view, the middle and lower segments of the humeral shaft are adjacent to important nerve and vascular structures, such as the radial nerve walking close to the posterolateral radial nerve groove of the middle and lower 1/3 segment of the humeral shaft. When a fracture occurs, the unstable fracture end can easily damage the radial nerve, causing serious dysfunction such as hanging wrist and finger, while the distal humerus has a complex anatomical structure, which consists of multiple parts, such as humeral trochlea, humeral capitulum, medial and lateral condyle, etc., which collectively form a crucial element for elbow flexion, extension, and rotational movements. Complex comminuted fracture will destroy the integrity of the articular surface of the distal humerus, affect the stability and mobility of the joint, and increase the risk of complications such as traumatic osteoarthritis. In clinical treatment, the middle and lower humeral shaft fractures combined with complex comminuted fractures of the distal humerus face many challenges. Due to the particularity and complexity of the fracture site, closed reduction is difficult, and most of them need open reduction and internal fixation. The correct surgical approach can better display the broken end of the fracture, which is conducive to the accurate reduction of the fracture. The plates and screws of the embedded objects can achieve optimal arrangement and distribution, and achieve strong fixation. The main points of diagnosis and treatment of this kind of complex fracture are discussed through typical cases and related literature.