桡骨头骨折伴肘关节周围骨性不稳定的治疗  

Treatment of fracture of radial head combined with bony instability around the elbow

作　　者：吴加东[1] 吕成堂[1] 郭宗信[1] 孙焕建[1] 周敦[1] 许步伟[1] 王玉武[1] 王友华[2] 刘璠[2] 

机构地区：[1]东南大学附属盐城医院骨科,江苏省盐城市224001 [2]南通大学附属医院骨科,226001

出　　处：《中华创伤骨科杂志》2016年第1期83-85,共3页Chinese Journal of Orthopaedic Trauma

基　　金：盐城市医学科技发展计划项目（YK2013068）

摘　　要：目的探讨桡骨头骨折伴肘关节周围骨性不稳定的治疗方法及疗效。方法回顾性分析2003年1月至2011年6月采用微型钢板或螺钉内固定治疗的31例桡骨头骨折伴肘关节周围骨性不稳定患者资料，男21例，女10例；年龄20～65岁，平均42．6岁。合并伤：冠状突骨折11例，鹰嘴骨折14例，肱骨小头骨折6例。桡骨头骨折按Mason分型：Ⅱ型13例，Ⅲ型18例。合并冠状突骨折患者，3例Ⅰ型骨折患者，若骨折块无移位，可行保守治疗，否则需手术取出突入关节间隙的游离骨块并缝合关节囊；7例Ⅱ、Ⅲ型骨折患者，选用克氏针、微型钢板固定骨折块，同时探查尺侧副韧带前束，如损伤予以修复或重建；1例Ⅳ型骨折患者，取自体骨重建冠状突，取白体掌长肌腱重建尺侧副韧带前束。合并鹰嘴骨折患者，若骨折粉碎不严重，复位后用克氏针张力带钢丝固定；若粉碎严重，则行钢板螺钉内固定，其中一期植骨6例。6例合并肱骨小头的Ⅰ型完全骨折采用双头加压螺钉固定。结果患者伤口均一期愈合，骨折愈合率为100％，愈合时间为3～6个月（平均5．1个月）。所有患者术后获18～36个月（平均24．3个月）随访。3例有创伤性关节炎表现，4例发生轻度异位骨化，肘关节平均屈伸范围为104°，前臂平均旋转活动范围为118°。按照Broberg＆Morrey评分标准评定肘关节功能：优7例，良15例，可6例，差3例，优良率为71．0％。结论对于桡骨头骨折伴肘关节周围骨性不稳定，可采用微型钢板或螺钉固定桡骨头骨折，同时注意对毗邻骨性结构如冠状突、鹰嘴及肱骨小头等损伤的治疗，修复或重建其稳定结构，以期肘关节功能良好恢复。Objective To investigate the therapeutic strategies of radial head fracture combined with bony instability around the elbow. Methods From January 2003 to June 2011, 31 patients with radial head fracture combined with bony instability around the elbow were treated. They were 21 males and 10 females, from 20 to 65 years of age （average, 42.6 years）. Ulnar coronoid process fracture was found in 11 patients, ulnar olecranon fracture in 14 and capitellum fracture in 6. The radial head fracture was Mason type Ⅱ in 13 patients and Mason type Ⅲ in 18. All patients with radial head fracture were treated with mini-plate or screws. The 3 cases of ulnar coronoid process fracture of type Ⅰ received conservative treatment when there was no displaced fracture fragment, or surgery after removal of the fragments in the joint and suture of the capsule. The 7 cases of type Ⅱand type Ⅲ fractures received internal fixation with Kirschner wire or micro-plate after the anterior bundle of the ulnar collateral ligaments （UCL） were repaired. Bone arid ligament reconstructions were necessary to rebuild elbow stability in one patient with type IV fracture. For the ulna olecranon fractures, Kirschner wire with tensile band was used in non-eomminuted ones, or plate and screw fixation and bone graft in the 6 comminuted ones. The 6 cases of type Ⅰ eapitellum fracture were treated with compression screw fixation. Results All wounds healed at the primary stage. All fractures united after 3 to 6 months （average, 5.1 months） . All the patients were followed up for 18 to 36 months （average, 24.3 months） . Traumatic osteoarthritis occurred in 3 cases, and mild heterotopic ossification in 4. The mean range of motion （ROM） of the affected elbow joint was 104°, and the ROM of forearm rotation was 118°. According to Broberg ＆ Morrey evaluation system, the elbow function was rated as excellent in 7 patients, good in 15, fair in 6 and poor in 3. The excellent and good rate was 71.0%. Conclusions In order to achieve good

关 键 词：肘关节 桡骨骨折 关节不稳定性 

分 类 号：R687[医药卫生—骨科学]