前内侧面尺骨冠状突骨折的手术治疗策略

Internal fixation for the treatment of anteromedial facet fracture of the coronoid process of ulna

目的:探讨手术治疗前内侧面尺骨冠状突骨折的手术入路选择、内固定方法及其疗效。方法:自2005年3月至2010年3月,采用手术内固定治疗前内侧面冠突骨折18例,男12例,女6例;年龄19～74岁,平均37.8岁。全部采用切开复位内固定治疗。取肘后正中切口,游离皮瓣后在外侧暴露肘关节外侧副韧带复合体及关节囊,采用不可吸收线缝合法或锚钉技术修复外侧副韧带复合体。根据术前三维重建图像上骨折情况及分型,分别选择3个不同的手术入路,暴露前内侧面冠状突骨折,采用微型钢板及螺钉固定。用MEPS(Mayo elbow performance score)和Broberg&Morrey评分对肘关节功能进行评价。结果:17例获得随访,时间1～6年,平均38个月;骨折均获临床愈合,愈合时间8～16周,平均11.6周。末次随访时,所有患者肘关节没有明显疼痛及不稳定。MEPS评分82～100分,平均(95.4±4.6)分;Broberg&Morrey评分75～100分,平均(92.3±5.8)分。结论:切开复位微型钢板内固定可使前内侧面冠状突骨折达到良好的解剖复位及坚强固定,是治疗前内侧面尺骨冠突骨折的有效方法。

Objective ：To investigate the effect of operative treatment for anteromedial facet fracture of the coronoid pro- cess of ulna,and to study its surgical exposures and fixation techniques. Methods：From March 2005 to March 2010,18 pa- tients with anteromedial facet fracture of the coronoid process of ulna were treated with open reduction and internal fixation. There were 12 males and 6 females with an average age of 37.8 years. A single midline posterior incision was used to expose the entire elbow joint. After elevating the full-thickness skin flaps, a lateral incision was made to expose and repair the lateral col- lateral ligament. Three intervals in the flexor-pronator musculature were used to gain access to the coronoid,depending on the size of the fracture fragment and the planned fixation technique. Fractures were fixed by using mini-plate or with screws. The therapeutic effects were evaluated by Mayo Elbow Performance Score （MEPS） and system of Broberg ＆ Morrey. Results：Sev- enteen patients were followed up, no patient complained pain and elbow unstable at a mean follow-up period of 38 months （ 1 to 6 years）. The fractures were clinically healed at an average time of 11.6 weeks（ranged from 8 to 16 weeks）. The average MEPS was 95.4±4.6 （ranged, 82 to 100）. The average functional rating of system of Broberg ＆ Morrey was 92.3±5.8 （ranged, 75 to 100）. Conclusion：Open reduction and internal fixation is effective to reach anatomical reduction and strong fixation for the treatment of anteromedial facet fracture of the coronoid process of ulna.