20例儿童尺骨冠状突骨折的临床治疗分析

Treatment for ulnar coronoid fracture in 20 children

目的:初步探讨儿童尺骨冠状突骨折的特点与治疗的方法。方法:回顾性分析2012年1月至2017年1月重庆医科大学附属儿童医院骨科病房收治的尺骨冠状突骨折患儿20例,男16例,女4例,年龄1～15岁,平均9.9岁。按Regan-morrey方法分型,I型10例,Ⅱ型7例,Ⅲ型3例;粉碎性骨折8例,伴其他部位骨折12例,伴肘关节脱位3例,无恐怖三联征及韧带断裂患儿;保守治疗6例,手术治疗14例;固定方式:空心钉1例,软骨钉7例,克氏针2例,缝线1例,清除碎骨块3例。结果:20例患儿均获9个月至5年随访,平均32个月。按照Mayo肘关节功能评价标准:优16例,良3例,可1例,差0例,优良率95%。结论:儿童尺骨冠状突骨折发生率低,粉碎性骨折多见,恐怖三联征及韧带断裂的情况极少见;常规侧位片检查可减少漏诊,妥善治疗预后均好,并发症发生率低;对于粉碎性骨折更推荐前侧入路软骨钉或克氏针固定。

Objective：To explore the characteristics and treatment for ulnar coronoid fracture in 20 children. Methods：From January 2012 to January 2017,20 children suffered from fracture of the coronoid process of the ulna were treated in the Children’s Hospital of Chongqing Medical University,including 16 boys and 4 girls,aged from 1 to 15 year with a mean age of 9.9 years. According to Regan-morrey classification,there were 10 cases of type I,7 cases of typeⅡ,3 cases of type Ⅲ. Eight cases were comminuted fracture,12 cases were concomitant with other fractures,3 cases were accompanied with elbow dislocation,and no case of ‘terrible triad of the elbow’ or ligament rupture was found. A total of 6 cases were treated conservatively while the other 14 cases were managed by operation：cannulated screw in 1 case,cartilage nails in 7 cases,Kirschner wire in 2 cases,absorbable suture in 1 case,removing the small bone fragments in 3 cases. Results：Mean follow up was 2.7 years（1 to 5 years）. According to Mayo scale,the functional re-covery assessed as excellent in 16 cases,good in 3 cases and fair in 1 case. Conclusion：In children,the incidence of ulnar coronoid fracture is rare,while most of them are comminuted fracture,and few are concomitant with the ‘terrible triad of the elbow’ and liga-ment rupture. The lateral X-ray examination can reduce the missed diagnosis. The prognosis of ulnar coronoid fracture is good,with few complications. The anterior approach is recommended for operation in cases with comminuted fracture in which cartilage nail or the Kirschner wire is recommended to fix.