尺骨冠突骨折的治疗  

Treatment of fracture of ulna coronoid process

作　　者：左玉明[1] 王志强[2] 王月光[1] 赵国志[1] 马松立[1] 

机构地区：[1]唐山市第二医院小儿骨科,063000 [2]唐山市第二医院创伤骨科,063000

出　　处：《中华骨科杂志》2006年第6期366-370,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨尺骨冠突骨折的治疗方法。方法1997年1月至2005年4月,共收治尺骨冠突骨折患者65例66侧,男54例,女11例12侧;年龄8￣76岁,平均32岁;左侧29例,右侧35例,双侧1例。摔伤22例23侧,交通伤16例,机器绞轧伤14例,坠落伤10例,其他伤3例。新鲜骨折60侧,陈旧性骨折6侧。闭合性骨折59侧,开放性骨折7侧。合并同侧肘关节其他部位骨折38侧。根据Regan-Morrey分型,将骨折分为三型:Ⅰ型骨折22例,Ⅱ型骨折29例30侧,Ⅲ型骨折8例,另外6例为尺骨冠突矢状面骨折(暂称为Ⅳ型骨折)。石膏固定37侧;切开复位内固定23侧,其中螺钉固定10侧,克氏针加张力带及钢丝固定7侧,克氏针加丝线固定3侧,单纯克氏针固定2侧,钢丝环扎固定1侧;骨片摘除5侧;冠突重建1侧。结果对随访资料完整的43例(44侧)患者进行7￣32个月随访,平均随访15个月,骨折均骨性愈合,愈合时间6￣16周,平均12.2周。根据Morrey肘关节功能评定标准评定疗效:优25侧(56.8%),良9侧(20.5%),可6侧(13.6%),差4侧(9.1%);优良率为77.3%。肘关节半脱位2侧,骨化性肌炎2侧,无深部感染、内固定松动或断裂、肘关节脱位及肘关节强直等严重并发症。结论Ⅰ型骨折及无移位或轻度移位的稳定性Ⅱ、Ⅳ型骨折宜采用保守治疗,对Ⅲ型骨折及明显移位的不稳定性Ⅱ、Ⅳ型骨折宜采用切开复位内固定进行治疗。Objective To explore the treatment of fracture of ulna coronoid process. Methods Sixty-five patients （66 cases） of fractures of ulna coronoid process were treated between January 1997 and April 2005. There were 54 males and 11 females with an average age of 32 years old （range, 8-76 years old）. 29 fractures occurred on the left extremity, 35 on the right and 1 on the bilateral. The mechanism of injury was fall in 23 sides, traffic injury in 16, wringer injury in 14, fall from a height in 10 and other trauma in 3. 60 cases were fresh fractures, 6 old fractures and 7 open fractures. 38 patient suffered multiple fractures in ipsilateral elbow. According to Regan-Morrey classification, there were 22 type Ⅰ, 30 type Ⅱ and 8 type Ⅲ. In addition, there were 6 cases with a sagittal fracture line which we defined them as ＂type Ⅳ＂. In this series, immobilization of the elbow in flexion or extension with a long arm plaster splint or cast were applied in 37 sides, open reduction and internal fixation in 23 sides, resection of fragments in 5 sides and reconstruction of coronoid process in 1. Results 43 cases（44 sides） were followed up for an average 15 months （range, 7-32 months）. All the fractures healed well, and the averaged union time was 12.2 weeks with a range of 6-16 weeks. The clinical results were evaluated according to Morrey＇s scale, 25 sides （56.8%） were rated as excellent, 9 （20.5%） as good, 6 （13.6%） as fair and 4（9.1%） as poor. No deep infection, loosening or breakage of the internal fixators and other severe complications occurred except for 2 cases with subluxation of elbow joint and 2 cases with myositis ossificans. Conclusion For type Ⅰ and some cases with a stable type Ⅱ and Ⅳ which have no or mildly displaced fragment of the coronoid process, conservative treatment are applicable. Open reduction and internal fixation are suitable for all type Ⅲ and some cases with an unstable type Ⅱ and Ⅳ which have a obviously displaced fragment of the coronoid pr

关 键 词：尺骨骨折 肘关节 脱位 

分 类 号：R683.4[医药卫生—骨科学]