肘前血管神经间隙入路治疗尺骨冠突骨折疗效分析

Treatment of ulnar coronoid process fracture through anterior elbow neurovascular gap approach

目的分析肘关节前方血管神经间隙入路治疗尺骨冠突骨折的疗效及安全性。方法2016年1月1日~2019年3月1日,纳入尺骨冠突骨折病例13例,均行肘关节前方肱动脉-正中神经血管神经间隙入路手术治疗。结果所有病人均获随访,随访时间8~50个月,平均29.1个月。所有骨折均顺利愈合,愈合时间为3~6个月,平均4.2个月。肘关节活动度伸直为10°~20°,平均(12.5±3.3)°;屈曲120°~140°,平均(134.3±5.5)°;前臂旋前旋后与健侧无明显差别。根据末次随访时MEPS评分,评分为70~98分,平均(92.5±7.3)分,肘关节功能优5例,良7例,中1例。1例病人出现肘关节轻微异位骨化,对肘关节功能无明显影响。1例病人术后肘关节活动时伴有轻度疼痛或酸胀感,局部外用镇痛药物可缓解。结论肘关节前方血管神经间隙入路可直视下清除/复位固定尺骨冠突骨折,是一种安全且有效的手术入路。

Objective To retrospectively analyze the efficacy and safety of anterior elbow neurovascular gap approach in the treatment of ulnar coronoid process fractures.Methods From January 1,2016 to March 1,2019,13 cases of ulnar coronoid process fracture were included.All patients were treated by the anterior brachial artery-median neurovascular internervation approach.Results All patients were followed up for 8-50 months(mean 29.1 months).All the fractures healed smoothly.The average healing time was 4.2 months(3-6 months).The range of motion of elbow joint was 10° to 20° with an average of(12.5±3.3)° and flexion of 120° to 140° with an average of(134.3±5.5)°.There was no significant difference with regard to pronation and supination compared to the healthy limb.According to the MEPS score at the last follow-up,the patient’s score was 70-98,with an average of(92.5±7.3).The elbow function was excellent in 5 cases,good in 7 cases and fair in 1 case.One patient had mild heterotopic ossification of elbow,which had no significant effect on elbow function.One patient had mild pain during elbow movement after operation,which could be relieved by topical analgesic drugs.Conclusion The anterior neurovascular gap approach of elbow can be used safely and efficiently for the treatment of the fracture of ulna coronoid process under direct vision.