目的 建立肱骨干下1/3骨折的分型系统，并进行可信度检验及临床效果评价。 方法 回顾性分析福州市第二医院创伤骨科于2013年1月至2020年12月期间收住院的88例肱骨干下1/3骨折患者资料。男61例，女27例；年龄（34.6±12.7）岁。根据骨折线的位置、移位情况、骨块情况将肱骨干下1/3骨折患者进行分型，共分为3型：Ⅰ型：横形、短斜形；Ⅱ型：斜形、螺旋形；Ⅲ型：斜形、螺旋形带蝶形骨块。选择初、中、高级三名骨科医师及一名影像科医师行此骨折分型学习，再独立进行分型评价，结果行一致性检验。本分型中Ⅰ、Ⅱ型骨折行外侧入路切开复位单钢板内固定、单钢板螺钉内固定，Ⅲ型骨折行尺侧结合前侧入路双钢板内固定术。术后观察桡神经、尺神经、肌皮神经功能以及骨折愈合时间；末次随访时采用Neer肩关节功能评分及Mayo肘关节功能评分评估肩、肘关节功能。 结果 本组88例患者中，Ⅰ型20例，Ⅱ型25例，Ⅲ型43例。观察者间第一阶段可信度Kappa值均值为0.878，第二阶段为0.914，观察者内可信度Kappa值均值为0.950。所有患者术后获（14.1±3.7）个月随访。2例医源性桡神经损伤，无一例患者发生尺神经损伤、肌皮神经及重要血管损伤及内固定失败。所有患者均获骨性愈合，骨折愈合时间（12.7±2.0）周。末次随访时肘关节最大屈曲范围137.8°±4.8°，肘关节最大伸直范围2.4°±1.6°，Mayo肘关节功能评分（92.0±3.1）分，Neer肩关节功能评分（92.2±3.2）分。 结论 肱骨干下1/3骨折分型系统可信度高，依据分型对肱骨干下1/3骨折采取相应治疗方式均取得较为满意的复位固定及功能恢复效果，对临床治疗方法选择具有一定的指导意义。 Objective To evaluate the reliability and clinical application of a self-established classification system for the lower 1/3 humeral fractures in adults. Methods A retrospective study was performed to analyze the 88 patients with lower 1/3 humeral fracture who had been admitted to Department of Orthopedics, The Second Hospital of Fuzhou between January 2013 and December 2020. There were 61 males and 27 females with an age of (34.6±12.7) years. The lower 1/3 humeral fractures were classified according to the location of the fracture line, displacement, and bone mass into 3 types: type Ⅰ: transverse and short oblique ones type Ⅱ: oblique and spiral ones type Ⅲ: oblique and spiral ones with butterfly-shaped bone mass. After a junior orthopedic surgeon, an intermediate orthopedic surgeon, a senior orthopedic surgeon, and a radiologist had learned this novel classification system, they were asked to classify the lower 1/3 humeral fractures in this cohort independently to assess the reliability of the classification system. Our treatments were based on this novel classification. Open reduction and internal fixation with a unilateral plate through a lateral approach was performed for type Ⅰ fractures, internal fixation with a unilateral plate plus compression screws through a lateral approach for type Ⅱ fractures, and double plate internal fixation through the ulnar and anterolateral approaches for type Ⅲ fractures. The functions of the radial, ulnar, and musculocutaneous nerves and fracture healing time were observed postoperatively. The shoulder and elbow functions were evaluated using Neer shoulder function score and Mayo elbow function score. Results Of the 88 patients in this cohort, 20 were type Ⅰ, 25 type Ⅱ, and 43 type Ⅲ. The mean Kappa value for inter-observer reliability was 0.878 at the first stage and 0.914 at the second stage, and the mean Kappa value for intra-observer reliability was 0.950. All patients were followed up for (14.1±3.7) months. Iatrogenic injury to the radial nerve was observed in 2 patients, but no injury to the ulnar nerve, the musculocutaneous nerve or important blood vessels or failure of internal fixation was reported. All patients achieved bony union after (12.7±2.0) weeks. The maximum elbow flexion was 137.8°±4.8°, and the maximum elbow extension 2.4°±1.6°. The Mayo elbow function score was (92.0±3.1) points and the Neer shoulder function score (92.2±3.2) points. Conclusions Our classification system for the lower 1/3 humeral fractures in adults is reliable. As the treatments corresponding to the novel classification system can achieve satisfactory clinical outcomes, the classification system has a clinical value.
Abstract
Objective To evaluate the reliability and clinical application of a self-established classification system for the lower 1/3 humeral fractures in adults. Methods A retrospective study was performed to analyze the 88 patients with lower 1/3 humeral fracture who had been admitted to Department of Orthopedics, The Second Hospital of Fuzhou between January 2013 and December 2020. There were 61 males and 27 females with an age of (34.6±12.7) years. The lower 1/3 humeral fractures were classified according to the location of the fracture line, displacement, and bone mass into 3 types: type Ⅰ: transverse and short oblique ones type Ⅱ: oblique and spiral ones type Ⅲ: oblique and spiral ones with butterfly-shaped bone mass. After a junior orthopedic surgeon, an intermediate orthopedic surgeon, a senior orthopedic surgeon, and a radiologist had learned this novel classification system, they were asked to classify the lower 1/3 humeral fractures in this cohort independently to assess the reliability of the classification system. Our treatments were based on this novel classification. Open reduction and internal fixation with a unilateral plate through a lateral approach was performed for type Ⅰ fractures, internal fixation with a unilateral plate plus compression screws through a lateral approach for type Ⅱ fractures, and double plate internal fixation through the ulnar and anterolateral approaches for type Ⅲ fractures. The functions of the radial, ulnar, and musculocutaneous nerves and fracture healing time were observed postoperatively. The shoulder and elbow functions were evaluated using Neer shoulder function score and Mayo elbow function score. Results Of the 88 patients in this cohort, 20 were type Ⅰ, 25 type Ⅱ, and 43 type Ⅲ. The mean Kappa value for inter-observer reliability was 0.878 at the first stage and 0.914 at the second stage, and the mean Kappa value for intra-observer reliability was 0.950. All patients were followed up for (14.1±3.7) months. Iatrogenic injury to the radial nerve was observed in 2 patients, but no injury to the ulnar nerve, the musculocutaneous nerve or important blood vessels or failure of internal fixation was reported. All patients achieved bony union after (12.7±2.0) weeks. The maximum elbow flexion was 137.8°±4.8°, and the maximum elbow extension 2.4°±1.6°. The Mayo elbow function score was (92.0±3.1) points and the Neer shoulder function score (92.2±3.2) points. Conclusions Our classification system for the lower 1/3 humeral fractures in adults is reliable. As the treatments corresponding to the novel classification system can achieve satisfactory clinical outcomes, the classification system has a clinical value.
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