复合阔筋膜髂骨重建尺骨冠状突9例临床观察

Reconstruct coronoid process of ulna with ilium-fascia lata complex tissue

目的 探讨尺骨冠状突基底部粉碎性骨折合并内侧副韧带撕裂,手术重建冠状突,修复内侧副韧带的方法.方法 用复合阔筋膜的髂骨重建尺骨冠状突,修复内侧副韧带前束,恢复肘关节前柱和内侧柱的解剖结构9例.全部病例有肘关节后脱位且冠状突基底部粉碎性骨折,合并尺骨鹰嘴骨折1例,桡骨头骨折5例.手术经肘内侧入路进入,摘除骨碎片,在髂嵴处切取复合有阔筋膜的髂骨块修整后植于缺损处,螺钉固定;用阔筋膜修复内侧副韧带及肘前关节囊.合并有桡骨头骨折、鹰咀骨折者可经附加的外侧切口复位固定;术后肘关节功能位制动3周.结果 按Morry肘关节评分评估疗效,优2例、良5例、可1例,差1例.优良率为77.8%.患者均未发生伤口感染、内固定松动或断裂、肘关节失稳、关节内游离体;2例合并轻度骨化性肌炎.结论 尺骨冠状突基底部粉碎性骨折的病例,应用带阔筋膜的髂骨重建冠状突同时兼顾了骨性结构重建和软组织重建,手术操作简化,效果可靠,功能恢复好.

Objective To analyze and explore the operative effect of coraccid process basilar part fractures combined injury of ligamental structure. Methods Use ilium-fascia lata complex tissue to reconstruct coronoid process of ulna and medial collateral ligament, recoverd anterior and wall horn anatomic structure of elbow joint. Total 9 cases of ulna coracoid process fractures concomitancy with elbow posterior dislocation . Among these one with olec-ranon fracture,five patients with head of radius fracture. Anterior trance joint approach was used,removal bone chips, restore defect with ilium-fascia lata complex tissue after cuting and trimming. Once reduction was achieved,fixed with screw. Repaird the collateral ligament and anterior joint capsule use the fascia lata, If there were combined fracture of the radius head or olecranon fracture,fixed through lateral approach,All injured extremities were treated with a posterior plaster splint with functional position for 3 weeks followed by elbow rehabilitation training. Results According to Moneys evaluation method,2 patients were classified as excellent ,5 as good,l as fair and 1 as poor. The excellent and good rate was 77. 8%. Two patients with gently ossifying myositis but no patients with wound infection,internal fixation loosening or break,elbow joint destabilizing orcorpus libemm. Conclusions Coracoid process basilar part fractures was simultaneous with the instability of osteal frame and soft tissue. To attain the favourable anatomical foundation for elbow joint functional recovery, it should rebuild the height and shape of coronoid process first and think highly of repair or rebuild medial collateral ligament and joint capsule. It reconstructed the coronoid process osteal frame and soft tissue instability at the same time to use ilium-fascia lata complex tissue. The operative procedure is simplify with reliability effect and fine functional rehabilitation.