钢板内固定治疗O'Driscoll Ⅱ型尺骨冠状突骨折  

Plate fixation for treatment of O'Driscoll type Ⅱ ulna coranoid process fractures

作　　者：魏万富[1] 林枫松[1] 刘欣[1] 郭知明[1] 赵德胜[1] 李明新[1] 张殿英[2] Wei Wanfu;Lin Fengsong;Liu Xin;Guo Zhiming;Zhao Desheng;Li Mingxin;Zhang Dianying(Department of Orthopedic Trauma,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院创伤骨科,300211 [2]北京大学人民医院创伤骨科,100044

出　　处：《中华肩肘外科电子杂志》2017年第4期293-298,共6页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：国家自然科学基金面上项目(31671246);国家重点研究计划专项(2016YFC1101604)

摘　　要：目的探讨钢板内固定治疗O'DriscollⅡ型尺骨冠状突骨折的临床效果。方法通过回顾性分析2014年1月至2016年12月天津市天津医院创伤骨科采用钢板内固定治疗O'DriscollⅡ型尺骨冠状突骨折患者资料,共有19例符合纳入条件,其中男15例,女4例;年龄22~54岁,平均37.5岁。按O'Driscoll分型标准均为Ⅱ型骨折,其中Ⅱ2型15例,Ⅱ3型4例。受伤至手术时间2~8 d,平均3.5 d。术后3 d开始有限制的肘关节屈伸活动。观察骨折复位情况、愈合时间、并发症及肘关节功能结果,采用Mayo肘关节功能评分(Mayo elbow performance score,MEPS)和Broberg-Morrey评分评定肘关节功能。结果 17例患者获随访,随访时间5~25个月,平均13.5个月。X线片示骨折愈合,愈合时间8~14周,平均11.2周。术后出现尺神经支配区域感觉障碍2例,于术后3~6个月恢复。无骨折再移位发生。最终肘关节活动范围屈曲(129±12)°,伸直(8±4)°,旋前(75±8)°,旋后(63±6)°。MEPS评分:优13例,良4例。Broberg-Morrey评分:优15例,良2例。结论钢板内固定治疗尺骨冠状突前内侧面骨折固定可靠,有利于恢复关节的稳定并促进骨折愈合,可早期功能锻炼。Background Coronoid process of ulna is an important stable structure of elbow joint.It can severely affect the stability of elbow joint after fracture.In the past,Morrey classification was often used in coronoid process fractures,which was according to the size of fracture fragment and could not reflect the mechanism of fractures.In 2003,the coronoid process fracture of ulna was classified by O'Driscoll et al.according to different parts of fracture fragments through CT scanning,of which type II fracture of ulnar coronoid process affected the anteromedial facet and more accurately reflected the mechanism of injury.This type of fracture has the obvious characteristics:the coronoid process fracture of medial articular facet was resulted from the mutual impact of pulley and coronoid process due to the lateral tension and medial pressure of varus elbow joint.The radiographic manifestations were coronoid process fracture of anteromedial facet or combined with lateral epicondylar avulsion fracture of humerus,and the elbow joint was often in subluxation.In the past,there was insufficient understanding of this injury,and problems such as elbow instability and joint degeneration might occur in the later stage.

关 键 词：尺骨冠状突 骨折 内固定 

分 类 号：R687.3[医药卫生—骨科学]