尺骨近端粉碎性骨折伴肘关节不稳定的治疗  

Treatment in the comminute fracture of proximal ulna associated with the elbow instability

作　　者：王友华[1] 刘璠[1] 周振宇[1] 吴菊[1] 陶然[1] 顾永强[1] 侍德[1] 

机构地区：[1]南通大学附属医院骨科, 南通226001

出　　处：《中华骨科杂志》2008年第4期283-287,共5页Chinese Journal of Orthopaedics

基　　金：江苏省科教兴卫工程重点医学人才项目（RC2007087）

摘　　要：目的探讨尺骨近端粉碎性骨折伴肘关节不稳定的治疗方法及疗效。方法尺骨近端粉碎性骨折伴肘关节不稳定患者33例，男23例，女10例；年龄21-61岁，平均41．3岁。11例合并桡骨头骨折，15例合并尺骨冠突骨折，7例同时合并桡骨头及尺骨冠突骨折。采用钢板螺钉内固定治疗，其中一期植骨9例。合并桡骨头骨折患者，如骨折粉碎不严重，复位后用克氏针固定，并修补环状韧带；如骨折粉碎严重，则行人工桡骨头置换，同时取自体掌长肌腱重建环状韧带。合并尺骨冠突骨折患者，12例Ⅱ、Ⅲ型骨折患者，选用克氏针或拉力螺钉固定骨折块，同时探查尺侧副韧带前束，如损伤予以修复或重建；4例Ⅳ型骨折患者，取自体骨重建冠突，取自体掌长肌腱重建尺侧副韧带前束。结果患者伤口均一期愈合，骨折愈合率为100％。术后随访8-36个月，平均22个月。3例有创伤性关节炎表现，4例发生轻度创伤性骨化。肘关节平均屈伸范围为112°±24°，前臂平均旋转活动范围为108°±27°。按照Morrey等肘关节功能评定标准进行评价：优10例，良14例，可7例，差2例，总优良率为72．7％。结论治疗尺骨近端粉碎性骨折伴肘关节不稳可采用钢板螺钉固定尺骨近端骨折，必要时行一期植骨，注意对桡骨头、尺骨冠突骨折及肘关节侧副韧带损伤的治疗，以防止肘关节不稳定。Objective To investigate the surgical management of the proximal ulnar comminuted fractures associated with the elbow instability and evaluate the clinical outcome. Methods From January 2003 to March 2006, 33 patients with proximal ulnar comminuted fractures associated with the elbow instability were treated, which involved 23 males and 10 females with an average age of 41.3 years. Radial head fractures were found in 11 patients, Ulna coronoid process fractures were found in 15 patients and both of them in 7 patients. All patients were treated with the plate and screw fixation. Bone graft had been done in 9 patients during the primary procedure. For radial head fractures, the internal fixation was performed in 11 patients, or radial head replacement in 7 patients. For the ulna coronoid process fracture type Ⅱ and type Ⅲ, internal fixation were performed and repaired the anterior bundle of the ulnar collateral ligaments （UCL） in 12 patients. Bone and ligament reconstruction was necessary to rebuild elbow stability in 4 patients with the ulna coronoid process fracture type Ⅳ. Results The mean time of the follow-up was 22 months. The union rate was 100%. No inflammation, neural injuries and elbow instability occurred. Traumatic osteoarthritis occurred in 3 cases, and mild heterotopic ossification occurred in 4 cases. The mean range of motion （ROM） of the affected elbow joint was 112°±24°, and the ROM of forearm rotation was 108°±27°. According to Morrey＇s evaluation method, 10 patients was classified in excellent, 14 in good, 7 in fair and 2 in poor. The excellent a nd good rate was 72.7%. Conclusion Elbow stability must be restored by addressing the specific components of the injury. The proximal ulna must be anatomically reduced and internally fixed; the radial head and substantial coronoid fractures must be repaired or reconstructed. The repair of the ligaments of elbow is necessary.

关 键 词：尺骨骨折 肘关节 关节不稳定性 

分 类 号：R687.3[医药卫生—骨科学]