角稳定钢板结合关节面下支撑治疗关节面粉碎的尺骨鹰嘴骨折  

The treatment of the olecranon comminuted fracture by angle stability principle combined with support under the artic-ular surface

作　　者：王世龙[1] 汤超亮[1] 张权[1] 陈文钧[1] 

机构地区：[1]复旦大学附属华山医院骨科,200040

出　　处：《中华骨科杂志》2014年第10期1008-1015,共8页Chinese Journal of Orthopaedics

摘　　要：目的：探讨角稳定原则结合关节面下支撑治疗关节面粉碎的尺骨鹰嘴骨折的疗效。方法回顾性分析2008年11月至2012年6月，采用Synthes解剖锁定加压钢板结合关节面下克氏针固定治疗13例关节面粉碎的尺骨鹰嘴骨折患者资料，男7例，女6例；年龄20~77岁，平均52岁；左侧9例，右侧4例。Mayo分型：ⅡB型11例，ⅢB型2例；Schatzker-Schmeling分型：A2型2例，C型9例，D型2例，其中C型骨折中1例伴Ⅰ型冠状突骨折（Regan和Morrey分型）。使用Mayo肘关节评分指数（Mayo elbow performance index, MEPI）和简化的臂肩手功能障碍评估表（the shortened disabilities of the arm, shoulder and hand, Quick-DASH）评价患者的术后功能，同时行满意度调查和X线片随访。结果13例患者均获得随访，随访时间8~41个月，平均20.2个月。肘关节屈伸活动65°~140°，平均112°，前臂旋转活动150°~180°，平均170°。MEPI评分85~100分，平均96分，其中优12例，良1例，优良率为100%。Quick-DASH量表得分0~16.7分，平均6.2分。满意度评价，8例为非常满意，4例为满意，1例为一般。骨折均完全愈合，愈合时间11~24周，平均12.7周；无一例发生内外翻畸形、不稳定、感染、尺神经损伤等并发症。术后5例诉内固定刺激引起轻度不适，其中3例屈伸活动度＜100°，被诊断为关节僵硬（1例取出内固定，1例取内固定同时行内侧副韧带松解，1例拒绝治疗）。结论 Synthes解剖锁定加压钢板螺钉角稳定结合克氏针关节面下支撑治疗关节面粉碎的尺骨鹰嘴粉碎性骨折固定确实，有利于肘关节早期活动，临床应用效果优良。Objective To evaluate the treatment effects of the olecranon comminuted fracture by the angle stability prin-ciple combined with support under the articular surface. Methods From November 2008 to June 2012, 13 patients （7 male and 6 female, aged from 20 to 77 years） suffered from olecranon comminuted fracture were treated with Synthes anatomy locking com-pression plate and screws combined with Kirschner wires supporting under the articular surface through the posterior median ap-proach. Fractures occurred in the left elbow in 9 and in the right elbow in 4. According to the Mayo classification, 11 cases were classified as Mayo type IIB and 2 as IIIB. According to the Schatzker-Schmeling classification, 2 fractures were type A2, 9 type C, and 2 type D. One patient with type C fracture also had type I coronoid fracture according to Regan and Morrey classification. The Mayo elbow performance index （MEPI） and the shortened disabilities of the arm shoulder and hand （Quick-DASH） were employed to evaluate the functions. All patients took the satisfaction survey and X-ray during the follow-up. Results All patients were fol-lowed-up for 8 to 41 months. The mean ROM of the elbow joint was 112° （range, 65°-140° ）, and the mean rotation angle of the forearm was 170° （range, 150°-180°）. The mean score for the MEPI was 96 （range, 85-100）, excellent 12, good 1. The mean score for the Quick-DASH was 6.2 （range, 0-16.7）. In the satisfaction survey, 8 patients were very satisfied, 4 satisfied, 1 common level. All patients took the X-ray during the follow-up and all of them had achieved fracture union completely with the mean time period as 12.7 weeks （range, 11-24 weeks）. No cubitus varus, valgus, and instability were found in all patients. No complication, such as infection, ulnar nerve injuries and etc. was found. Five patients complained about mild discomfort caused by internal fixation at 3 months after surgery. Three of them were diagnosed as joint stiffness because of ROM within 100° . O

关 键 词：尺骨鹰嘴 骨折 骨折 粉碎性 骨折固定术 

分 类 号：R687.3[医药卫生—骨科学]