新型张力带系统治疗Ⅰ型尺骨鹰嘴骨折

Surgical treatment of type Ⅰ olecranon fracture with new tension band system

目的：探讨钛缆加空心钉结合新型垫片内固定治疗Ⅰ型尺骨鹰嘴骨折的疗效。方法2012年2月至2014年2月北京大学第三医院采用直径3.0 mm 空心钉、钛缆与新型垫片系统内固定治疗I 型尺骨鹰嘴骨折患者21例,其中男10例,女11例,平均年龄57.2岁（20~80岁）,受伤机制均为滑倒时肘部着地。结果手术时间43~236 min,平均71.3 min。术后无需外固定,术后1周开始肘关节主动功能活动,并逐渐增加活动范围。术后随访时间为12~20个月,平均18个月；骨折愈合时间8~12周,平均10.5周。肘关节 HSS 评分80~100分,平均91.2分,其中优11例,良10例,所有患者无并发症出现。结论钛缆加空心钉结合新型垫片的新型张力带系统在治疗Ⅰ型尺骨鹰嘴骨折方面固定可靠、操作简单、疗效显著,有较好的临床应用价值。

Background Olecranon fracture is a common fracture of upper extremity and frequently occurs in adults,accounting for about 10% of elbow fractures and 1% of systematic fractures.At present,the common internal fixation method for smaller fragment at the proximal end of the olecranon （Schatzker type I fracture）has deficiencies.The Kirschner wire and tension band fixation reveals complications of poor strength,implant withdraw,etc.and the Cable-pin and the locking plate cannot effectively fix the small fragment,which may result in further fragmentation. This paper aims to explore the clinical outcome of type I olecranon fracture treated with a novel tension band system.Methods General information 21 patients with type I olecranon fracture were treated in Peking University Third Hospital from February 2012 to February 2014,including 1 1 female patients and 10 male patients.The mean age was 57.2 years （ranging from 20 to 80 years old）.8 cases were in the left side and 13 cases were in the right side.The injury mechanism was slip and fall with elbow to the ground and all the cases were type I transverse fractures of olecranon tip according to Schatzker classification.Operation methods after brachial plexus block anesthesia,the patient was in supine position and the affected limb was placed in front of the chest.A posterior medial incision was made from the 1/4 part of proximal ulna to the posterior radial side of elbow to expose the fracture sites. The fracture ends as well as the intra-articular blood clots were carefully debrided.The fragment was reduced in elbow extension with towel clamps for temporary fixation.The longitudinal incision was made slightly above the triceps tendon to expose the olecranon convexity.Two Kirschner wires of＆amp;nbsp;2.0 mm were inserted into the ulnar medullary cavity from the midpoint of olecranon convexity in the posterior side, and the two insertion points were 1 cm apart. After the C-arm fluoroscopic confirmation of successful fracture reduction and good Kirschner wire positons,the Kirschner wires were withdrawn successively and replaced with two cannulated screws of 3.0 mm and gaskets （40-45 mm in length,Weigao company）.The gasket was specially designed with tiny holes for the threading of titanium cable.The cannulated screws were tightened after the titanium cable was threaded through both the gaskets and the triceps tendon.The bone tunnel was drilled transversely in the ulnar crest which was approximately 4 cm from the fracture line.After the titanium cable was threaded through the bone tunnel and made an 8-shaped cross on the dorsum of ulna,the titanium cable was tightened up,locked and clipped.The elbow joint was mobilized to observe the rigid fixation of fracture, and then the wound was closed in layers after rigorous hemostasis.Postoperative treatment external fixation was not essential after surgery.Postoperative routine treatment was applied and the preventable prophylactic antibiotics was used within 24 hours.The patient was guided to perform passive flexion and extension activities of elbow joint 24 hours after operation with 2 to 3 times per day.The active function was performed 1 week after operation and the range of motion was gradually increased till the function of elbow was fully recovered.Evaluation criteria and follow-ups The operation time,fracture healing time,postoperative complications and HSS score of elbow joint were recorded.Results The operation time was 43 to 236 minutes （average 71.3 minutes）.All the patients were followed up for 12 to 20 months （average 18 months）.The fracture healing time was 8 to 12 weeks （average 10.5 weeks）.The HSS score of elbow joint was 80 to 100 points （average 91.2 points）.Among them,1 1 cases were excellent,10 cases were good,and no complications were found in all the patients.Conclusions The new type tension band,which is simple to operate and reliable on internal fixation,is an effective treatment for olecranon fracture.Patients also can take exercise as early as possible.Therefore,the new type tension band has a better clinical value.