肘关节损伤三联征Adams分型中尺骨冠突骨折块形态学分析  

Morphological analysis of coronoid process fracture in terrible triad of elbow based on Adams classification

作　　者：蓝文彬[1] 林培森[1] 王发圣[1] 谢昀[1] Lan Wenbin;Lin Peisen;Wang Fasheng;Xie Yun(Department of Traumatology and Orthopedics,First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院创伤骨科,福州350005

出　　处：《中华创伤杂志》2022年第3期220-226,共7页Chinese Journal of Trauma

基　　金：福建省科协科技创新项目(FJKX-A2034)。

摘　　要：目的:基于Adams冠突分型,探究肘关节损伤三联征尺骨冠突骨折块形态特点。方法:采用回顾性横断面研究分析2013年1月至2021年8月福建医科大学附属第一医院收治的51例肘关节损伤三联征患者的肘关节CT三维数据,其中男33例,女18例;年龄18~88岁[(44.7±12.0)岁]。利用CT三维重建技术建立尺骨冠突骨折模型,并依据Adams尺骨冠突骨折分型对其进行分类,其中Ⅰ型为冠突尖端骨折、Ⅱ型为冠突横断形骨折、Ⅲ型为冠突基底部骨折、Ⅳ前内型为冠突前内侧斜行骨折、Ⅳ前外型为冠突前外侧斜行骨折。依据冠突骨折块的特点,Ⅳ前外型骨折分为两个亚型,即累及冠突尖端的α亚型和未累及冠突尖端的β亚型。测量不同类型尺骨冠突骨折块占比情况、高度、表面积、体积。同时测量Ⅳ前外型两种亚型尺骨冠突骨折块占比情况、高度、表面积、体积,尺骨滑车关节面面积、骨折块滑车关节面面积、骨折块滑车关节面面积损伤占比,以及尺骨上尺桡关节面面积、骨折块上尺桡关节面面积、骨折块上尺桡关节面面积损伤占比。结果:肘关节损伤三联征患者中尺骨冠突骨折块AdamsⅠ型17例(33%),Ⅱ型4例(8%),Ⅲ型4例(8%),Ⅳ前内型4例(8%),Ⅳ前外型22例(43%)。其中Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ前内型和Ⅳ前外型的高度分别为(3.7±1.9)mm、(10.8±1.1)mm、(14.4±1.2)mm、(5.2±2.4)mm、(6.7±2.6)mm;其表面积分别为63.7(21.4,221.0)mm 2、1086.8(606.8,1434.2)mm 2、1658.8(1335.6,1695.4)mm 2、437.3(185.6,437.3)mm 2、511.8(198.8,646.5)mm 2;其体积分别为46.3(21.4,180.5)mm 3、938.7(629.8,1011.3)mm 3、1797.4(1520.2,1903.7)mm 3、429.3(138.1,992.4)mm 3、461.9(144.9,707.1)mm 3。不同Adams分型尺骨冠突骨折块高度、表面积及体积差异有统计学意义(P均<0.01)。22例Ⅳ前外型尺骨冠突骨折中α亚型12例,β亚型10例。Ⅳ前外型中α及β两种亚型骨折块的高度分别为(8.6±2.6)mm、(5.0±2.4)Objective To explore the morphology of coronoid process fracture in terrible triad injury based on Adams classification.Methods A retrospective cross-sectional study was used to analyze the three-dimensional CT data of 51 patients with terrible trind injury treated at First Affiliated Hospital of Fujian Medical University from January 2013 to August 2021,including 33 males and 18 females,aged 18-88 years[(44.7±12.0)years].The model of ulna coronoid process fracture was established by three-dimensional CT reconstruction technology and was classified according to Adams coronoid process fracture classification.Type I was the coronoid process tip fracture,type II the coronoid process transverse fracture,type III the base fracture of the coronoid process,type IV anterior internal fracture the anteromedial oblique fracture of the coronoid process,and type IV anterior external fracture the anterolateral oblique fracture of the coronoid process.According to the characteristics of the coronoid fracture fragment,type IV anterior external fracture was divided into two subtypes:αsubtype involving the coronoid tip andβsubtype without involving the coronoid tip.Then,the proportion,height,surface area and volume of different types of coronoid fractures were measured.The proportion,height,surface area and volume of fracture fragments of two subtypes of type IV anterior external fracture were measured,as well as the area of ulnar trochlear joint,area of trochlear joint of ulnar fracture fragment,proportion of the area of trochlear joint affected by the ulnar fragment,area of proximal radioulnar joint,area of proximal radioulnar joint of ulnar fracture fragment and proportion of the area of proximal radioulnar joint affected by the ulnar fragment.Results Among the patients with terrible triad injury,the ulnar coronoid process fracture was Adams type I in 17 patients(33%),type II in 4(8%),type III in 4(8%),type IV anterior internal fracture in 4(8%)and type IV anterior external fracture in 22(43%).The height of fracture fragment

关 键 词：肘关节 尺骨骨折 肘关节损伤三联征 

分 类 号：R684[医药卫生—骨科学]