重建钢板联合张力带治疗尺骨上段合并鹰嘴骨折  

TREATMENT OF PROXIMAL ULNA AND OLECRANON FRACTURES BY RECONSTRUCTION PLATE COMBINED WITH TENSION BAND WIRING

作　　者：滕林[1] 钟刚[1] 肖聪[1] 刘刚[1] 项舟[1] 岑石强[1] 黄富国[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2011年第1期17-20,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨重建钢板联合张力带治疗尺骨上段合并鹰嘴骨折的临床疗效。方法 2004年11月-2009年9月,采用重建钢板联合张力带治疗10例尺骨上段合并鹰嘴骨折患者。男6例,女4例;年龄21～75岁,平均45.3岁。致伤原因:交通事故伤5例,高处坠落伤2例,摔伤2例,机器绞榨伤1例。左侧5例,右侧5例。其中开放骨折1例,为GustiloⅡ型;余均为闭合骨折。尺骨上段粉碎性骨折6例,斜形骨折4例;鹰嘴横断骨折4例,粉碎性骨折6例。合并同侧桡骨头骨折6例,冠状突骨折4例,肱骨近端骨折2例,肩胛骨骨折3例,肘关节脱位1例,肩关节脱位1例。2例曾于外院行克氏针张力带内固定治疗,效果欠佳,分别于伤后50 d及120 d入院行二次手术;其余患者均为首次手术,受伤至手术时间为7～20 d,平均11 d。结果 1例术后1周出现切口感染,经抗感染治疗和局部换药2个月后愈合;其余患者切口均Ⅰ期愈合。患者均获随访,随访时间12～64个月,平均40.5个月。X线片检查示,骨折均于术后10～24周达临床愈合,平均12周。术后均无尺神经损伤症状发生。术后2个月出现异位骨化1例,术后3个月出现肘关节僵硬1例,均经对症处理后好转;术后6个月克氏针尾退出皮肤1例,因骨折已愈合于术后9个月取出克氏针。末次随访时,患者肘关节屈伸度为23～130°,平均92.8°;前臂旋转度为42～175°,平均124.4°。肘关节功能按照美国特种外科医院(HSS)评分标准评定疗效,获优6例,良2例,一般1例,差1例。结论 重建钢板联合张力带治疗尺骨上段合并鹰嘴骨折,术后患者可早期行功能锻炼,并减少并发症的发生。Objective To review the efficacy of reconstruction plate combined with tension band wiring for treating proximal ulna and olecranon fractures.Methods Between November 2004 and September 2009,10 patients with proximal ulna and olecranon fractures were treated by reconstruction plate combined with tension band wiring.There were 6 males and 4 females with an average age of 45.3 years（range,21-75 years）.Five fractures were caused by traffic accident,2 by falling from height,2 by tumbling,and 1 by a machine strangulation.The locations were the left side and the right side in 5 cases respectively.One case was open fracture（Gustilo Ⅱ） and the other 9 were closed fractures.Olecranon fractures included 4 cases of traverse fractures and 6 cases of comminuted fractures,and proximal ulna fractures included 6 cases of comminuted fractures and 4 cases of oblique fractures.The combined fractures included 6 radial head fractures,4 coronoid process fractures,2 proximal humerus fractures,and 3 scapula fractures;other injury included 1 elbow dislocation and 1 shoulder dislocation.Two patients had secondary operation;the other 8 patients received the primary operations and the time from injury to operation varied from 7 days to 20 days,with an average of 11 days.Results One case had infection at the incision 1 week after operation,and recovered after 2 months of antibiotics and debridement;incisions healed by first intention in other 9 patients.All patients were followed up 12-64 months（mean,40.5 months）.The X-ray films showed that fracture healing was achieved at 10-24 weeks（mean,12 weeks）.There was no ulnar nerve symptom in all cases.Heterotopic ossification occurred in 1 case at 2 months and stiffness of the elbow in 1 case at 3 months after operation;they were both cured after symptomatic treatment.Proximal migration of Kirschner wires was found in 1 case at 6 months after operation,whose implants were taken out at 9 months after the first operation because fracture had healed.At last follow-up,the flexion and

关 键 词：重建钢板 张力带 尺骨上段骨折 鹰嘴骨折 

分 类 号：R687.3[医药卫生—骨科学]