后内侧双钢板治疗复杂尺骨鹰嘴骨折的疗效观察

EFFECTIVENESS OF POSTEROMEDIAL DOUBLE PLATES IN TREATMENT OF COMPLEX OLECRANAL FRACTURE

目的探讨后内侧双钢板治疗复杂尺骨鹰嘴骨折的疗效。方法回顾分析2011年9月-2015年7月采用尺骨鹰嘴解剖钢板联合内侧微型钢板治疗的13例复杂尺骨鹰嘴骨折患者临床资料。男8例，女5例；年龄22-68岁，平均41．6岁。致伤原因：交通事故伤4例，高处坠落伤6例，金属物击伤3例。均为闭合性损伤。骨折根据Mayo分型标准：ⅡB型5例，ⅢB型8例。合并冠状突骨折7例，均为Regan—MorreyⅢ型；肘关节前脱位5例，后脱位2例。受伤至入院时间1．5～10．0h，平均5．7h。术后x线片复查骨折愈合情况；末次随访时，根据Broberg—Morrey肘关节功能评价标准评定肘关节功能。结果术后患者切口均I期愈合，无尺神经损伤等相关并发症发生。患者均获随访，随访时间9～38个月，平均22．1个月。x线片复查示骨折均愈合，愈合时间3．0～5．5个月，平均3．7个月；发生1例桡骨头半脱位，1例轻度异位骨化，但无肘关节屈伸活动障碍、关节不稳定及疼痛不适症状，未给予特殊处理。末次随访时，肘关节伸屈活动度达95-130°，平均116．4°；旋转活动度为150～175°，平均170．8°；肘关节功能按Broberg—Morrey肘关节功能评价标准，获优4例，良7例，可2例，优良率84．6％。无内固定失败、肘关节僵硬及创伤性骨关节炎等并发症发生。结论尺骨鹰嘴解剖钢板联合内侧微型钢板可牢固固定骨折、重建滑车切迹，允许术后早期锻炼，治疗复杂尺骨鹰嘴骨折可获得满意疗效。

Objective To evaluate the effectiveness ofposteromedial double plates in the treatment of complex olecranal fracture. Methods Between September 2011 and July 2015, 13 patients with complex olecranal fractures were treated with posterior olecranon locking compression plate and medial mini-plate. There were 8 males and 5 females with an average age of 41.6 years （range, 22-68 years）. Injury was caused by traffic accident in 4 cases, falling from height in 6 cases, and crush by object in 3 cases. According to the Mayo classification, fracture was rated as Mayo type IIB in 5 cases and as Mayo type IIIB in 8 cases. Of 13 cases, 7 had Regan-Morrey type III coronoid fractures, including 5 anterior dislocations of the elbow joint and 2 posterior dislocations. The time between injury and admission ranged from 1.5 to 10.0 hours （mean, 5.7 hours）. At last follow-up, the elbow function was assessed according to the Broberg- Morrey evaluation criteria. X-ray films was performed to observe fracture healing. Results All incisions healed at first stage and no neural complications occurred. The patients were followed up 9-38 months （mean, 22.1 months）. All patients achieved bone union at 3.0-5.5 months （mean, 3.7 months） according to X-ray results. Subluxation of radial head and mild heterotopic ossification occurred in 1 patient respectively, who had no uncomfortable symptoms of movement disorder, elbow instability and pain, and no special management was performed. At last follow-up, the flexion and extension range of motion （ROM） of the elbow was 95-130° （mean, 116.4°）; the rotation ROM of the forearm was 150-175° （mean, 170.8°）; and the elbow function was excellent in 4 cases, good in 7 cases, and fair in 2 cases, and the excellent and good rate was 84.6%. No internal fixation failure, elbow stiffness, or traumatic arthritis occurred. Conclusion For complex olecranal fractures, an early and stable anatomic reconstruction of trochlear notch in the olecranon with posterior olecranon locking compression plate and medial mini-plate can obtain good effectiveness in joint functions.