老年性肘关节骨折脱位的手术治疗  

Surgical treatment for the fractures and dislocations of the elbow in old patients

作　　者：许桦[1] 沈立锋[1] 俞华军[1] 张晓文[1] 郭峭峰[1] 

机构地区：[1]浙江省立同德医院,浙江杭州310012

出　　处：《中国骨伤》2017年第1期79-82,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨手术联合外固定治疗老年性肘关节骨折脱位的方法及疗效。方法:回顾性分析2011年7月至2015年8月收治的老年性肘关节骨折脱位7例,其中三联征损伤5例。桡骨头骨折按Mason法分类:Ⅰ型1例,Ⅱ型3例,Ⅲ型1例。尺骨冠突骨折按Regan-Morrey法分类:Ⅰ型1例,Ⅱ型5例,Ⅲ型1例。7例均采取了手术内固定治疗,桡骨头骨折予钢板或Herbert钉固定,尺骨冠状突骨折根据骨折类型予缝线或克氏针或钢板螺钉内固定,并修复侧副韧带。术后屈肘90°前臂旋转中立位石膏外固定3周,3周后拆除石膏改用肘关节可活动铰链支具辅助锻炼。结果:7例均获随访,时间13~48个月,平均20个月,骨折愈合较满意,肘关节稳定,无疼痛。Mayo肘关节功能评分:优3例,良3例,可1例。结论:老年性肘关节骨折脱位骨质疏松,骨量低下,术中难以稳定内固定,经辅助外固定可获得较好的功能恢复。Objective ：To introduce and report the preliminary results of 7 old patients with fractures and dislocations of the elbow. Methods：From July 2011 to August 2015,7 old patients suffered from fractures and dislocations of the elbow （5 of which were terrible triad）. One patient had type Ⅰ radial head fracture,3 type Ⅱ and 1 type Ⅲ according to the Mason classification, and 1 type Ⅰ , 5 type Ⅱ and 1 type Ⅲ according to the Regan-Morrey classification. All the 7 patients received operation and then were treated with external fixation. Fractures of the radial head were fixed with Herbert screws or locking plates and screws. Fractures of ulnar coronoid were reduced and fixed with lag screws or K-wires or PDS sutures or locking screws according to the types. The lateral and medial collateral ligaments were also repaired. Plaster external fixation was applied for 3 weeks after operation, in the position with elbow flexion in 90 degrees and forearm rotation in neutral. External fixation braces were used for each patient after the plasters were removed, and at the same time rehabilitation programs were carried out. Results ： All the 7 patients were followed up, and the during ranged from 13 to 48 months （averaged, 20 months）, with healed fractures, stable elbow and no pain movement. The functional outcome was excellent in 3 patients, good in 3 and fair in 1 according to the Mayo Elbow Performance Score （MEPS）. Conclusion：It is not easy to get stable fixation for fractures and dislocations of the elbow in old patients with osteoporosis and low density of bone, but the operation can achieve satisfied clinical outcomes after external fixation.

关 键 词：肘关节 骨折 脱位 桡骨头 尺骨冠突 内固定 

分 类 号：R683.2[医药卫生—骨科学]