尺骨冠状突骨折的手术治疗

Surgical Treatment of Fracture of Ulna Coronoid Process

目的探讨尺骨冠状突骨折的手术适应证、入路及内固定方法。方法自1998年1月～2005年1月手术治疗尺骨冠状突骨折患者23例(24侧)。Regan-Morrey分型:Ⅰ型1例,Ⅱ型15例(16侧),Ⅲ型7例。内固定方法:克氏针张力带钢丝及螺丝钉固定各6侧,克氏针加丝线固定3侧,单纯克氏针固定2侧,钢丝环扎固定1侧,骨片摘除5侧,冠状突重建1侧。结果对随访资料完整的20例(21侧)进行9～28个月(平均19个月)的随访,根据肘关节活动范围、疼痛程度、肌力,以及稳定性进行评定疗效:优9侧,良6侧,可3侧,差3侧,优良率71.4%。肘关节半脱位2例,骨化性肌炎2例,无肘关节脱位及肘关节强直等严重并发症。结论Ⅲ型骨折、明显移位及伴有肘关节不稳的Ⅱ型骨折宜采用手术治疗;手术不仅可以复位、固定骨折,同时也可修复或重建损伤的韧带,可早期行肘关节功能练习;正确的手术入路及内固定方法是提高疗效的关键。

Objective To explore the surgical indications, surgical approaches and the methods of internal fixation of fracture of ulna coronoid process. Methods Twentythree patients （24 sides） with the fracture of ulna coronoid process were treated surgically between January 1998 and January 2005. According to Regan- Morrey classification, there were Ⅰ patient with type Ⅰ fracture, 16 with type Ⅱ and 7 with type Ⅲ. Methods of internal fixation： Kirschner wires tension band and screws were used for fixation in 6 sides respectively, Kirschner wires with the silk thread in 3, Kirschner wires in 2 and steel wire in 1. The bone fragments were resected in 5 sides and the coronoid process was reconstructed in 1 side. Results Twenty patients （21 sides） were followed up for an average 19 months （range, 9 to 28 months）. The clinical results were evaluated according to the range of motion of the elbow, pain, the muscular strength and the stability. Nine sides were rated as excellent, 6 as good, 3 as fair and 3 as poor. The excellent and good rate was 71.4 %. No severe complications occurred except for 2 patients with subluxation of elbow joint and 2 patients with myositis ossificans. Conclusion The patients with type Ⅲ, and with unstable type Ⅱ and some patients with type Ⅱ who have the obviously displaced fragment of the coronoid process should be treated with operation. The surgical treatment not only can reduce and fix fractures, repair or reconstruct ligaments but also can facilitate the early functional exercises of elbow joint. A proper surgical approach and internal fixation are the key procedure to guarantee the satisfactory outcome.