内侧单切口双窗口入路治疗尺骨冠状突骨折

Treatment of ulnar coronoid process fractures through the medial operative approach of double windows in a single incision

目的分析尺骨冠状突周围的相关解剖特征，设计肘关节内侧单切口双窗口入路显露尺骨冠状突，探讨该入路治疗尺骨冠状突骨折的手术方法及临床疗效。方法选取3具成人尸体标本（共6侧）进行肘关节冠状突相关的解剖研究，探讨显露及内固定尺骨冠状突的合理方法，设计单切口双窗口人路并模拟手术；对临床11例肘关节冠状突骨折患者应用本研究实施切开复位内固定术，术后可调式支具外固定4～6周，术后1周开始渐进肘关节屈伸功能锻炼。末次随访采用MEPS及Bmberg～Morrey评分系统评估肘关节功能。结果术后随访12～24个月，平均15．5个月，所有患者骨折均I期愈合，未出现神经血管损伤并发症，无骨折再移位及内固定失效。末次随访MEPS评分：优6例，良4例，可1例。结论内侧单切口双窗口入路治疗尺骨冠状突骨折能提供良好的显露，利于骨折复位和固定，临床治疗效果满意。

Objective To analyze the related anatomical characteristics around ulnar coronoid process, design the medial operative approach of double windows in a single incision to expose ulnar coronoid process, and explore the surgical methods and clinical effects of this approach in the treatment of ulnar coronoid process fractures. Methods Three adult cadaveric specimens （6 sides） were used to perform anatomy research related to ulnar coronoid process of elbow joint. The reasonable methods of exposure and internal fixation of ulnar coronoid process were discussed. We designed the medial operative approach of two windows in a single incision and simulated operation. 11 cases of ulnar coronoid process fractures were treated by open reduction and internal fixation through the approach. After the operation, the adjustable orthosis of elbow joint were used for 4 to 6 weeks. The flexion and extension function of the elbow joint was gradually exercised 1 week after the operation. The elbow joint function was evaluated by MEPS and Broberg-Morrey scoring system at the last follow-up. Results All the patients were follow-up for 12 to 24 months with an average of 15.5 months. All the fractures achieved primary healing without complications of neurovascular injury. No fracture re-displacement and internal fixation failure occurred. The MEPS score of the last follow-up was excellent in 6 cases, good in 4 cases and fair in 1 case. Conclusion The medial operative approach of double windows in a single incision for the treatment of ulnar coronoid process fractures can provide good exposure, which is conducive to fracture reduction and fixation with satisfactory clinical effects.