尺骨冠突骨折的分型及治疗  

Classification and treatment in the ulna coronoid process fractures

作　　者：王友华[1] 刘璠[1] 周振宇[1] 吴菊[1] 侍德[1] 

机构地区：[1]江苏南通大学附属医院骨科,226001

出　　处：《中华骨科杂志》2006年第6期361-365,共5页Chinese Journal of Orthopaedics

基　　金：教育部优秀骨干教师研究基金(9701);江苏省"135"重点人才基金(2001-34)

摘　　要：目的探讨尺骨冠突骨折的分型及治疗方法。方法31例尺骨冠突骨折患者,男19例,女12例;年龄18～52岁,平均29.8岁。根据尺骨冠突骨折线的位置、尺侧副韧带是否损伤、冠突受损程度及对肘关节稳定性的影响分为四型:尺骨冠突尖部不超过冠突高度1/2骨折为Ⅰ型;尺骨冠突高度1/2处骨折为Ⅱ型,常合并尺侧副韧带前束损伤;尺骨冠突基底部骨折为Ⅲ型,常伴肱尺关节半脱位或后脱位,偶伴尺侧副韧带前束损伤;尺骨冠突严重粉碎性骨折伴肘关节不稳定,须行冠突和尺侧副韧带前束重建为Ⅳ型。31例尺骨冠突骨折患者Ⅰ型11例,Ⅱ型9例,Ⅲ型6例,Ⅳ型5例。针对不同类型骨折选择相应的治疗方法。结果患者伤口均一期愈合,骨折愈合率为100%。术后随访18～72个月,平均28.6个月。无一例发生感染、神经损伤和肘关节不稳定,但Ⅲ型1例及Ⅳ型2例有创伤性关节炎表现,Ⅲ型2例及Ⅳ型2例发生异位骨化。Ⅳ型骨折患者术后患侧肘关节活动范围明显小于健侧(P<0.05)。结论Ⅰ型冠突骨折可行保守治疗,若骨折片移位突入关节间隙影响肘关节活动,可手术摘除碎骨片;Ⅱ型和Ⅲ型冠突骨折可行切开复位内固定,同时注意修补或重建韧带以稳定肘关节;Ⅳ型冠突骨折,应重建冠突及尺侧副韧带前束,并保持冠突的高度达到原高度的1/2以上,同时加强术后功能锻炼。Objective To study the classification, management and outcome of the fracture of ulna coronoid process. Methods Retrospective analysis was carried out in 31 patients with fracture of ulna coronoid process. There were 19 males and 12 females with an average age of 29.8 years old （range, 18-52 years old）. The fractures of ulna coronoid process were classified into 4 major groups based on the condition of the injury of ulna coronoid process, the anterior bundle of the ulnar collateral ligaments（UCL） and the elbow stability. The fracture of coronoid process within half of the height was defined as type Ⅰ. The half of coronoid process fracture with the injury of UCL was defined as type Ⅱ. The base of coronoid process fracture with the dislocation of elbow joint was defined as type Ⅲ, sometimes with the injury of UCL. The severe cornminute fracture of coronoid process with elbow instability was defined as type Ⅳ. There were 11 cases in type Ⅰ, 9 type Ⅱ, 6 type Ⅲ and 5 type Ⅳ in our group. According to the type of injury we choose correlative treatment. Results The follow-up was 18-72 months（average 28.6 months）. All the patients got fracture union, and without inflammation, neural injuries and elbow instability. 1 type Ⅲ and 2 type Ⅳ had traumatic osteoarthritis, and 2 type Ⅲ and 2 type Ⅳ occurred heterotopic ossification. There was a statistical signif- icance when the motion range of two-side joints was compared in type IV. Conclusion We choose conservative treatment in the fracture of type Ⅰ . But if the piece of bone affected motion of elbow joint, we can choose operative treatment, and elbow stability is not affected. The fracture of type Ⅱ and type Ⅲ with elbow instability should be reduced internal fixation and the ligament must be repaired or reconstructed. In cases of type Ⅳ, bone reconstruction is necessary to recover of elbow stability. Proper post-operative rehabilitation can decrease the rate of traumatic osteoarthritis.

关 键 词：尺骨骨折 肘关节 关节不稳定性 

分 类 号：R683.4[医药卫生—骨科学]