中国修复重建外科杂志

中国修复重建外科杂志

改良肘关节前内侧入路治疗尺骨冠状突骨折

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目的 探讨改良肘关节前内侧入路治疗尺骨冠状突骨折的临床疗效。 方法 2010 年 1 月—2014 年 12 月,采用改良肘关节前内侧入路治疗 13 例尺骨冠状突骨折患者。其中,男 10 例,女 3 例;年龄 18~57 岁,平均 37.2 岁。致伤原因:交通事故伤 5 例,高处坠落伤 7 例,硬物撞击伤 1 例。损伤类型:肘关节恐怖三联征 7 例,冠状突骨折合并同侧桡骨头骨折 4 例,尺、桡骨近端关节内粉碎双骨折 1 例,冠状突骨折合并同侧桡骨远端骨折 1 例。尺骨冠状突骨折按照 Regan-Morrey 分型:Ⅱ型 2 例,Ⅲ型 11 例;按照 O’Driscoll 分型:冠状突前内侧面骨折 10 例(Ⅱb 型 8 例、Ⅱc 型 2 例),基底部骨折 3 例。记录尺骨冠状突骨折复位内固定手术时间、术中出血量以及相关并发症发生情况。通过 X 线片及临床检查判断骨折是否愈合,记录愈合时间。测量肘关节屈伸、旋转活动度,根据 Mayo 肘关节功能指数(MEPI)评价肘关节功能。 结果 手术时间为 30~55 min,平均 38.7 min;术中出血量为 90~160 mL,平均 109.3 mL。术后切口均Ⅰ期愈合,无医源性血管、神经损伤发生。患者均获随访,随访时间 13~24 个月,平均 16.9 个月。骨折均达临床愈合,愈合时间 8~16 周,平均 11.2 周;2 例异位骨化形成。末次随访,肘关节活动度屈 119~145°,平均 132.4°;伸 –8~15°,平均 7°;前臂旋前 68~90°,平均 78.6°;旋后 76~90°,平均 84.3°。MEPI 为 70~100 分;其中优 9 例,良 3 例,可 1 例,优良率 92.3%。 结论 改良肘关节前内侧入路治疗尺骨冠状突骨折,可以避开肘部重要血管、神经,直视下进行骨折块复位、固定,是一种安全、简便、有效的手术入路。

Objective To observe the effectiveness of reduction and fixation by the improved elbow anteromedial approach in treatment of ulna coronoid process fracture. Methods Between January 2010 and December 2014, 13 patients with the ulna coronoid process fracture were treated with reduction and fixation by the improved elbow anteromedial approach. There were 10 males and 3 females with an average age of 37.2 years (range, 18-57 years). Five cases were caused by traffic accident, 7 cases by falling injury from height, and 1 case by object impact injury. Seven cases were the terrible triad of the elbow, 4 cases were the ulna coronoid process and radial head fractures, 1 case was the proximal radius and ulna fractures, and 1 case was the ulna coronoid process and distal radius fractures. According to Regan-Morrey classification criteria, the ulna coronoid process fracture was rated as type Ⅱ in 2 cases and as type Ⅲ in 11 cases. According to O’Driscoll classification criteria, 10 of the 13 cases were anterior coronoid fracture (8 cases of type Ⅱb, 2 of type Ⅱc), and 3 of basal fracture. The operation time, amount of intraoperative bleeding, postoperative complications, range of motion (ROM) of the elbow joint, Mayo elbow function index (MEPI) score and fracture healing time were recorded. Results The average operation time was 38.7 minutes (range, 30-55 minutes), and the average amount of intraoperative bleeding was 109.3 mL (range, 90-160 mL). All incisions healed at stage Ⅰ. There was no iatrogenic vascular or nerve injury. All patients were followed up 13-24 months (mean, 16.9 months). All fractures achieved clinical healing. The average healing time was 11.2 weeks (range, 8-16 weeks). There were 2 cases of heterotopic ossification. At last follow-up, the ROM of elbow flexion was 119-145° (mean, 132.4°); the ROM of elbow extension was –8-15° (mean, 7°). The ROM of forearm pronation was 68-90° (mean, 78.6°), and the ROM of forearm supination was 76-90° (mean, 84.3°). At last follow-up, the MEPI score was 70-100; and 9 cases were excellent, 3 cases were good, and 1 case was fair. The excellent and good rate was 92.3%. Conclusion Improved elbow anteromedial approach for the ulna coronoid process fracture can not only avoid the injuries of surrounding blood vessels and nerves, but also perform fracture reduction and fixation under direct vision. It is a safe, simple, and effective treatment method for the ulna coronoid process fracture.

关键词: 尺骨冠状突骨折; 肘关节; 前内侧入路; 旋前圆肌

Key words: Ulna coronoid process fracture; elbow; anteromedial approach; pronator teres muscle

引用本文: 杨冬松, 陈宏峰, 郭前进, 甄相周, 刘理迪. 改良肘关节前内侧入路治疗尺骨冠状突骨折. 中国修复重建外科杂志, 2017, 31(12): 1409-1413. doi: 10.7507/1002-1892.201701091 复制

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