肘前方入路内固定治疗尺骨冠状突骨折

Internal fixation through anterior elbow approach for treatment of ulnar coronoid process fracture

目的探讨肘前方入路内固定治疗尺骨冠状突骨折的临床疗效。方法回顾性分析2013年1月—2019年11月重庆医科大学附属第一医院骨科收治的19例尺骨冠状突骨折患者,其中男性14例,女性5例;年龄16~61岁,平均31.8岁。平路摔伤11例,高处坠落伤5例,道路交通伤3例。均为闭合性骨折。根据O’Driscoll分型Ⅰ型4例,Ⅱ型8例,Ⅲ型7例。均使用肘前方入路,根据骨折情况行空心螺钉或微型钢板固定。术后早期行肘关节功能锻炼。定期随访记录患者肘关节活动度及并发症,检查肘关节稳定性,肘关节总体功能采用Mayo肘关节功能评分评价。结果19例患者均获得随访。随访时间12~28个月,平均19.1个月。肘关节平均屈曲120.5°(95°~140°),伸直24.2°(0°~50°),前臂旋转活动度平均旋前55.2°(20°~90°),旋后66.6°(30°~90°)。术后Mayo肘关节功能评分优10例,良8例,优良率94.7%。无正中神经损伤、严重肘关节不稳定及疼痛等并发症发生。结论肘前方入路内固定治疗尺骨冠状突骨折,能获得充分的暴露、稳定的固定,允许肘关节早期功能锻炼,是一种安全有效的手术入路。

Objective To investigate the efficacy of internal fixation through anterior elbow approach on ulnar coronoid process fracture.Methods Nineteen patients with closed ulnar coronoid process fractures were followed up between Jan.2013 and Nov.2019,involving 14 male patients and 5 female patients aged of 31.8(16-61)years.Eleven cases were injured from stumbling,5 from high falling and 3 from traffic accident.Among these patients,4 patients had O’Driscoll type I fracture,8 patients had O’Driscoll type II fracture,and 7 patients had O’Driscoll type III fracture.All patients underwent open reduction and internal fixation through anterior elbow approach.The fracture was fixed with hollow screws or microplates.Functional exercise of the elbow was performed in early stage.The elbow’s movement range,stability and painfulness were recorded in postoperative follow-up.And the overall function was assessed through Mayo elbow performance score.Results All of the patients were followed up for 12-28 months,19.1 months in average.The mean flexion arc was 120.5°(from 95°to 140°),the mean extension arc was 24.2°(from 0°to 50°),the mean pronation arc was 55.2°(from 20°to 90°),and the mean supination arc was 66.6°(from 30°to 90°).With the Mayo elbow performance score,10 patients achieved excellent result,and 8 patients achieved good result,witn an excellent and good rate of 94.7%.No patient complained about serious elbow painfulness,elbow instability,median nerve palsy or other surgical complications.Conclusion The anterior elbow approach is a safe and effective approach for internal fixation of ulnar coronoid process fracture,which allows full exposure,provides stable fixation and minimal soft tissue injury,so functional exercise of the elbow can be performed in early stage.