前后联合入路治疗经鹰嘴肘关节骨折脱位

Combined anterior and posterior approach in treatment of transolecranon fracture-dislocation

目的探讨前后联合入路治疗经鹰嘴肘关节骨折脱位的临床疗效。方法回顾性分析2010年9月至2014年10月采用肘关节前后联合入路治疗的6例经鹰嘴肘关节骨折脱位患者资料，男4例，女2例；年龄25．63岁，平均42．5岁。开放性损伤1例（Gustilo．AndersonI型），闭合性损伤5例。合并伤：尺骨冠状突骨折6例，桡骨头骨折5例。术后根据肘关节正、侧位X线片观察骨折愈合的情况，末次随访时通过肘关节Broberg-Morrey功能评分评定疗效。结果术后切口均一期愈合，无早期并发症发生。6例患者术后获平均14个月（9．22个月）随访，术后6个月时骨折均已愈合。末次随访时肘关节的平均活动范围：屈伸127°（90°～145°），旋转112°（80～150°），Broberg-Morrey功能评分平均89分（74～96分），其中优2例，良3例，可1例。未出现肘关节不稳、异位骨化和内固定物松动、断裂等情况。结论肘关节前后联合入路治疗经鹰嘴肘关节骨折脱位视野清晰，有利于解剖复位并坚强固定，术后可早期行肘关节功能锻炼，短期疗效佳。

Objective To observe the treatment of transolecranon fracture-dislocation using combined anterior and posterior approach. Methods From September 2010 to October 2014, 6 patients （4 males and 2 females） with transolecranon fracture-dislocation were treated via the combined anterior and posterior approach at our department. Their average age was 42.5 years （from 25 to 63 years） . One case had open injury （Gustilo-Anderson type I） and 5 closed injury. Six cases were associated with corouoid process fracture and 5 with radial head fracture. Bone union was assessed by elbow anterioposterior and lateral radiographs. The elbow function was assessed at the last follow-up according to the Broberg-Morrey functional rating indexes. Results All the 6 patients achieved primary incision healing with no early complications. They were followed up for an average period of 14 months （from 9 to 22 months） . All fractures healed 6 months post-operation. At the last follow-up, the average elbow flexion range was 127° （from 90°to 145°） and the average rotation range was 112° （from 80° to 150°）. The mean Broberg and Morrey functional score was 89 points （from 74 to 96 points）. Two cases were excellent, 3 good, and one moderate. No implant failure, heterotopic ossification or elbow instability was observed at the last follow-up. Conclusion In treatment of transolecranon fracture-dislocation, com- bined anterior and posterior approach provides clear vision which benefits anatomical reduction and stable fixa- tion. Also it allows early mobilization of the elbow and leads to good short-term results.