尺骨鹰嘴横形开放骨折合并尺神经断伤的手术疗效分析

Open transverse olecranon fracture accompanied with ulnar nerve injury： analysis of surgical treatment results

目的探讨尺骨鹰嘴横形开放骨折合并尺神经断伤手术治疗的临床疗效。方法回顾性分析2003年8月-2007年6月收治的21例尺骨鹰嘴横形开放骨折合并尺神经断伤的患者，采用AO空心钉和钢丝张力带固定尺骨鹰嘴骨折，修复和皮下前置尺神经，支具保护下早期功能锻炼。结果术后18例获得12～19个月的随访，平均13个月；3例失访。肘关节功能按Broberg-Morrey评分标准评估：优14例，良3例，可0例，差1例；优良率为94．0％。尺神经疗效评定根据英国医学研究会颁布的感觉（S）、运动（M）分级标准评定疗效：优M4S3 6例，良M3S3 10例，可M2S2 1例，差M1S1以下1例；优良率为88．9％。结论尺骨鹰嘴横形开放骨折合并尺神经断伤，采用可靠的内固定和尺神经前置修复方法，结合早期功能锻炼，可明显提高术后的疗效。

Objectives To evaluate the surgical results of open transverse olecranon fracture accompanied with ulnar nerve injury. Methods Twenty-one cases of open transverse olecranon fracture with ulna nerve injury treated from August 2003 to June 2007 were retrospectively analyzed. All fractures were treated by AO cannulated screws plus traditional tension band fixation. The ulnar nerves were repaired by end- to-end epineurial neurerrhaphy and anterior subcutaneous transposition. Early functional exercise started two weeks after the operation. Results Eighteen cases were followed up for 12 to 19 months with an average period of 13 months. The elbow joint function was evaluated with Broberg-Morrey grading system. Results of treatment were graded as excellent in 14 cases, good in 3 cases, and poor in 1 case. The overall good- excellent rate was 94.0%. The surgical results of ulnar nerve were evaluated by the sensory （ S ） and motor （M） grading system published by Medical Council of Britain. Results were excellent（ M4S3） in 6 cases, good （M3S3） in 10 cases, fair （M2S2） in 1 case, and poor（M1S1） in 1 cases. The good-excellent rate was 88.9%. Conclusion Open transverse olecranon fracture with ulnar nerve injury should be treated by reliable internal fixation and repair and anterior subcutaneous transposition of the ulnar nerve. Assisted with early functional exercise, this surgical procedure can lead to satisfactory results.