不同类型尺骨鹰嘴骨折的内固定选择

Treatment options for different types of olecranon fractures

目的 探讨不同类型尺骨鹰嘴骨折内固定的选择策略.方法 对2007年2月至2009年11月不同手术方法治疗的62例尺骨鹰嘴骨折患者资料进行回顾性分析,其中张力带固定组36例,男17例,女19例,平均42.7岁;骨折按照Schatzkeer分型：A型13例,B型8例,C型10型,D型3例,E型1例,F型1例;采用克氏针张力带（28例）及Cable-Pin（8例）固定;钢板固定组26例,男11例,女15例,平均43.9岁;骨折按照Schatzkeer分型：A型8例,B型6例,C型7型,D型2例,E型1例,F型2例;采用普通解剖钢板或锁定接骨板固定.采用Broberg-Morrey肘关节评分评定功能,并比较两组患者的优良率.结果 本组患者术后获得6～24个月（平均11个月）随访.术后6个月Broberg-Morrey肘关节评分,张力带组：优14例,良16例,可4例,差2例,优良率83.3%;钢板组：优11例,良11例,可3例,差1例,优良率84.6%,两组优良率比较差异无统计学意义（χ2=1.484,P=0.361）.张力带组有5例患者发生骨折复位丢失,其中B型3例,C、D型各1例;钢板组随访期间无内固定松动、无骨折移位,但D、F型各有1例患者出现骨化性肌炎.结论 张力带技术对于简单移位骨折固定可靠,但粉碎性、斜行及脱位型骨折则适用钢板固定.

Objective To discuss options of internal fixation devices for different types of olecranon fractures. Methods A retrospective analysis was done for 62 patients with olecranon fractures who had been treated in our department from February 2007 to November 2009. Of them, 36 cases were treated with tension band wiring （TBW） and 26 cases with plating. The differences between the 2 groups were compared according to Broberg and Morrey scales. Results The patients were followed up for 6 to 24 months （average, 11 months） . There were no significant differences between the 2 groups in terms of scores of Broberg and Morrey scales （χ2 = 1. 484, P =0. 361 ） . There were 5 losses of reduction in the TBW group while there were 2 cases of myositis ossificans in the plating group. Conclusions Internal fixation by TBW is preferred in the majority of patients with simple olecranon fractures. Dorsal plating is particularly indicated in the comminuted fracture and fracture dislocations.