尺骨冠突骨折的治疗分析

The analysis of the treatment for the ulna coronoid process fracture

目的 分析尺骨冠突骨折的治疗方法。方法 2010年1月-2015年1月,共收治尺骨冠突骨折患者35例,男21例,女14例;年龄19-55岁,平均30.6岁。左侧12例,右侧23例。根据国内王友华分型方法,Ⅰ型骨折9例,Ⅱ型骨折14例,Ⅲ型骨折7例,Ⅳ型骨折5例。针对不同类型骨折选择相应的治疗方法,石膏固定保守治疗10例;切开复位内固定22例,其中螺钉固定11例,克氏针加张力带及钢丝固定9例,克氏针加丝线固定2例;冠突重建1例,骨片摘除2例。结果 术后随访6-36个月,平均24.2个月。患者伤口均一期愈合,骨折均骨性愈合。所有患者术后无神经损伤和肘关节不稳定。根据Morrey肘关节功能评定标准评定疗效：优20例（57.1%）,良8例（22.8%）,可5例（14.2%）,差2例（5.7%）;优良率为79.9%。肘关节骨化性肌炎2例,创伤性关节炎表现3例,无肘关节强直等其它严重并发症。结论Ⅰ型尺骨冠突骨折除了骨折块突入关节间隙影响肘关节活动,需行手术摘除碎骨片,其余可行保守治疗;Ⅱ型冠突骨折若骨折块无明显移位,也可采用石膏后侧外固定肘关节于功能位进行治疗。若内侧韧带损伤严重,则行韧带的修复或重建。Ⅲ、Ⅳ型冠突骨折不仅需行切开复位内固定,而且同时注意修补或重建韧带以稳定肘关节。

Objective To analysis the treatment of fracture of ulna coronoid process. Methods Thirty-five patients of fractures of ulna coronoid process were treated between Jan 2010 and Jan 2015. There were 21 males and 14 females with an average age of 30.6 years old （range, 19 to 55 years old）. 12 fractures occurred on the left extremity, 23 on the right. According to WANG You-hua classification, there were 9 type Ⅰ, 14 type Ⅱ, 7 type Ⅲ and 5 type Ⅳ. According to the type of injury, we choose correlative treatment. （In this series, immobilization of the elbow in flexion or extension with a long arm plaster splint were applied in 10 cases, open reduction and intemal fixation in 22 cases, resectionoffragments in 2 cases. Results 35 cases were followed up for an average 24.2 months （range, 6 to 36 months）. All the fractures healed well. All the patients without neural injuries and elbow instability. The clinical results were evaluated according to Morrey＇s scale, 20 cases （57.1%） were rated as excellent, 8 （22.8%） as good, 5 （14.2%） as fair and 2 （5.7%） as poor. No severe complications occurred except for 2 cases with myositis ossifieans of elbow joint and 3 cases with traumaticosteoarthritis. Conclusion An type-l ulna eoronoid process fracture can take conservative treatment, butifthe piece ofbone affected motion ofelbowjoint, it must be choose operative treatment to remove it. Type Ⅱ which have no or mildly displaced fragment of the eoronoid process, conservative treatment with a long arm plaster splint are applicable. But if the interior ligament injure serious, we can repair or reconstruct the ligament. TypeⅢ and Ⅳ were not only need to open reduction and internal fixation, but also need to repair or reconstruct the ligament.