指总伸肌劈开入路联合袢钢板技术治疗肘关节恐怖三联征中尺骨冠状突骨折  

Extensor digitorum communis split approach combined with loop-plate technique for treatment of ulnar coronoid fracture in terrible triad of elbow

作　　者：杨佳瑞 何晓[2] 乔瑞 王志猛 李树灏 黄伟[3] 王晓龙 樊伟[3] 衡立松[3] 朱养均[3] 张堃[3] YANG Jiarui;HE Xiao;QIAO Rui;WANG Zhimeng;LI Shuhao;HUANG Wei;WANG Xiaolong;FAN Wei;HENG Lisong;ZHU Yangjun;ZHANG Kun(Xi’an Medical University,Xi’an Shaanxi,710068,P.R.China;Medical Department of Yan’an University,Yan’an Shaanxi,716000,P.R.China;Department of Orthopaedic Trauma,Honghui Hospital Affiliated to Xi’an Jiaotong University,Xi’an Shaanxi,710054,P.R.China)

机构地区：[1]西安医学院,西安710068 [2]延安大学医学部,陕西延安716000 [3]西安交通大学附属红会医院创伤骨科,西安710054

出　　处：《中国修复重建外科杂志》2021年第4期420-425,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：陕西省自然科学基金资助项目(2017SF-197)。

摘　　要：目的探讨单纯外侧指总伸肌(extensor digitorum communis,EDC)劈开入路联合袢钢板固定治疗肘关节恐怖三联征(terrible triad of elbow,TTE)损伤中尺骨冠状突骨折的临床疗效。方法回顾分析2015年1月—2018年5月收治且符合选择标准的60例TTE患者临床资料。男48例,女12例;年龄18~60岁,平均37.4岁。均为闭合性骨折,致伤原因:摔伤28例,高处坠落伤20例,交通事故伤12例。所有患者均无血管、神经损伤,受伤至手术时间1~14 d,平均4.8 d。通过CT测量冠状突骨折块的高度、大小并予以精确分型。60例患者均行单纯外侧EDC劈开入路联合袢钢板固定尺骨冠状突骨折;桡骨头骨折采用空心螺钉固定20例、微型钢板固定32例、桡骨头假体置换8例;16例采用骨钻孔缝线、44例采用带线锚钉修复重建外侧副韧带复合体;10例肘关节残余不稳使用铰链式外固定支架固定,其余患者术后使用可调张力性支具固定。术后行影像学检查评估骨折愈合,内固定物松动、断裂,骨关节炎和异位骨化等并发症发生情况;随访时记录肘关节活动范围(range of motion,ROM),包括肘关节屈曲、伸直和前臂旋前、旋后;末次随访时采用Mayo肘关节功能评分系统(MEPS)评价肘关节功能。结果 60例均获随访,随访时间16~24个月,平均20.2个月。术后患者切口均Ⅰ期愈合,无血管神经损伤、内固定失败、感染等并发症发生;骨折愈合时间9~17周,平均11.7周。术后4例出现肘关节僵硬,均于术后12~15个月行内固定物取出肘关节松解术;10例出现异位骨化,未行特殊治疗。末次随访时,肘关节ROM为屈曲85°~135°(平均116°),伸直0°~20°(平均11°);前臂旋前55°~75°(平均70°),旋后60°~90°(平均83°)。根据MEPS评分评价肘关节功能,为55~100分,平均86.1分;获优40例、良10例、可6例、差4例,优良率83.3%。结论单纯外侧EDC劈开入路暴露充分,袢钢板固定尺骨冠状突骨折牢靠稳定,可恢�Objective To explore the effectivenesss of simple lateral extensor digitorum communis(EDC) split approach combined with loop-plate fixation in the treatment of ulnar coronoid fracture in terrible triad of elbow(TTE).Methods The clinical data of 60 patients with TTE who met the selection criteria between January 2015 and May 2018 were retrospectively analyzed. There were 48 males and 12 females, aged from 18 to 60 years(mean, 37.4 years). All the patients were closed fractures. Injury causes included fall injury in 28 cases, falling from height in 20 cases, and traffic accident injury in 12 cases. All patients had no vascular and nerve injury, and the time from injury to operation was 1-14 days, with an average of 4.8 days. The height and size of the fracture of the coronal process were measured by CT and accurate classifications were made. All the 60 patients were treated with simple lateral EDC split approach combined with loop-plate to fix the ulnar coronoid fracture;20 patients of radial head fracture were fixed with hollow screw, 32 patients with mini-plate fixation, 8 patients with radial head prosthesis replacement;16 patients with suture and 44 patients with suture anchor to reconstruct lateral collateral ligament complex;10 patients with residual instability of elbow joint were fixed with hinge external fixator, and others were fixed with adjustable tension brace after operation. Postoperative imaging examination was performed to evaluate fracture healing and complications, such as loosening or breakage of internal fixator, osteoarthritis, and heterotopic ossification, etc. During follow-up, the range of motion(ROM) of the elbow joint was recorded, including elbow flexion, extension, and forearm pronation, supination. Mayo elbow function score system(MEPS) was used to evaluate elbow joint function at last follow-up. Results All patients were followed up16-24 months(mean, 20.2 months). All incisions healed by first intention after operation, and no complications such as vascular nerve injury, elbow joint i

关 键 词：肘关节恐怖三联征 指总伸肌劈开入路 袢钢板 尺骨冠状突骨折 

分 类 号：R687.3[医药卫生—骨科学]