解剖型锁定接骨板内固定治疗尺骨冠状突骨折疗效分析

Curative effect analysis of anatomical locking plate internal fixation for treatment of ulna coronary process fractures

目的探讨解剖型锁定接骨板内固定治疗尺骨冠状突骨折的疗效。方法回顾性分析自2014-03—2016-12采用肘关节内侧入路解剖型锁定接骨板内固定治疗的21例尺骨冠状突骨折。复位骨折块后用细克氏针临时固定,放置尺骨冠状突解剖型锁定接骨板,调整接骨板尾椎的位置,桨状翼环抱关节囊及内侧副韧带,置入4~6枚直径2.5 mm锁定螺钉固定钢板。结果 21例均获得随访,随访时间平均16(6~21)个月。术后侧位X线片测量尺骨冠状突高度平均18.3(15.9~19.0)mm,滑车切迹开口纵径平均20.1(17.9~21.3)mm,张开角平均29.8°(29.6°~30.3°)。末次随访时肘关节屈伸活动范围11°~126°,旋前平均53.3°(41°~58°),旋后平均57.6°(49°~62°)。末次随访时肘关节功能按Broberg-Morrey评分标准评定:优11例,良8例,可2例,优良率90.5%。无肘关节不稳、疼痛及异位骨化等并发症发生。结论肘关节内侧入路解剖型锁定接骨板内固定治疗尺骨冠状突骨折能够有效恢复尺骨冠状突解剖形态,维持尺骨冠状突高度,降低肘关节不稳、关节僵硬等并发症发生率,疗效满意。

Objective To investigate the effect of anatomical locking plate internal fixation in the treatment of ulna coronoid process fractures. Methods A retrospective analysis of 21 cases of ulnar coronoid fractures treated by anatomical locking plate internal fixation with medial approach of elbow from March 2014 to December 2016 was conducted. After the reduction of the fractures, it was temporarily fixed with a fine Kirschner needle. The ulnar coronal anatomical locking plate was placed, the posterior vertebral body of the plate was adjusted, and the inner accessory ligament and the sacs of the oar wing were closed. Four to six locking screws with diameter of 2.5 mm were placed. Results All 21 patients were followed up for an average of 16 （6-21） months. Postoperative lateral X ray film measured： ulna coronoid process height was average 18.3 （15.9- 19.0） ram, the longitudinal diameter of trochlear notch openings was on average 20.1 （17.9-21.3） ram, the angle was on average, 29.8° （29.6°-30.3°）. At the last follow-up, the elbow flexion and extension range was 11°-126°, pronation on average 53.3° （41°-58°）, supination on average 57.6° （49°-62°）. At the last follow-up visit, elbow function was assessed according to Broberg-Morrey scoring criteria： 11 excellent cases, 8 good cases, 2 fair cases, with an excellent and good rate of 90.5%. No complications such as elbow instability, pain and heterotopic ossification occurred. Conclusion Anatomic locking plate internal fixation for treatment of ulna coronoid process fractures is satisfying, it can effectively restore coronoid process condyle anatomical contour, maintain coronoid process height, reduce the complications such as elbow instability and joint stiffness.