前内侧入路微型钢板内固定治疗尺骨冠状突骨折

Mini-plate fixation of ulnar coronoid process fracture via anteromedial approach

目的探讨前内侧入路微型钢板内固定治疗尺骨冠状突骨折的临床效果。方法回顾性分析2010年4月-2014年12月采用前内侧入路微型钢板内固定治疗的28例尺骨冠状突骨折患者，其中男18例，女10例；年龄21～60岁，平均34．3岁。尺骨冠突骨折按O’Driscoll分型标准：Ⅰ型骨折14例，Ⅱ型骨折11例，Ⅲ型骨折3例。受伤至手术时间2～10d，平均3．7d。观察骨折复位丢失情况、骨折愈合时间和并发症情况。采用Mayo肘关节功能评分（MEPS）和Broberg＆Morrey评分评定肘关节功能。结果28例患者均获随访12～25个月，平均15．1个月。术后1周开始有限制的肘关节屈伸活动。X线片示骨折均临床愈合，愈合时间8～14周，平均10．6周。无神经损伤及骨折再移位发生。最后随访时屈曲（124±15）°（90°～140°），伸直丢失（18±20）°（0°～50°），旋前（65±18）°（40°～85°），旋后（63±16）°（35°～85°），与术前比较差异均有统计学意义（P〈0．05）。肘关节功能根据MEPS：优17例，良8例，一般2例，差1例。根据Broberg＆Morrey评分：优16例，良8例，一般3例，差1例。结论前内侧入路微型钢板内固定治疗尺骨冠状突骨折固定可靠，有利于恢复关节的稳定并促进骨折愈合，可早期功能锻炼。

Objective To investigate the clinical efficacy of mini-plate fixation for ulnar coronoid process fracture via anteromedial approach. Methods A retrospective review was made on 28 cases of ulnar coronoid process fracture treated with open reduction and mini-plate fixation from April 2010 to December 2014. There were 18 males and 10 females, with age range of 21-60 years （mean, 34.3 years）. Causes of injury were falls in 21 cases and traffic accidents in 7 cases. According to the O＇ Driscoll classification, there were 14 cases of type I , 11 cases of type 11 and 3 cases of type HI. Time from injury to operation was 2-10 d （mean, 3.7 d）. Reduction loss, fracture healing time and complications were documented. Elbow function was evaluated at the last follow-up by Mayo elbow performance score （MEPS） and Broberg ＆ Morrey score. Results All cases were followed up for 12-25 months （mean, 15.1 months）. Restricted elbow activity was initiated one week after operation. Bone united in mean 10.6 weeks （range, 8-14 weeks ）. No nerve injury or fracture redisplacement occurred. At the final follow-up, mean flexion was （ 124 ± 15 ） ° （ range, 90°-140°） , mean extension loss was （ 18 ± 20 ） ° （ range, 0°- 50° ） , mean pronation was （ 65 ±18 ） ° （ range, 40°- 85 ° ） , and mean supination was （ 63 ±16）°（ range, 35°- 85°）, showing significant difference in comparison with the preoperative measure （P 〈0. 05）. Aeeording to the MEPS, the results were excellent in 17 cases, good in 8, fair in 2 and poor in 1. Aecording to the Broberg ＆ Morrey score, the resuhs were excellent in 16 cases, good in 8, fair in 3 and poor in 1. Conclusion Through anteromedial approach, mini-plate fixation of the ulnar coronoid process fracture provides rigid fixation,which benefits joint stability and bone union, and allows early functional exereise.