合并尺骨干经尺骨鹰嘴骨折并肘关节前脱位的手术治疗

Surgical treatment of proximal ulnar metaphysis fracture associated with trans-olecranon anterior fracture dislocation of the elbow

目的探讨双钢板联合克氏针张力带钢丝内固定术治疗合并尺骨干经尺骨鹰嘴骨折并肘关节前脱位的临床疗效。方法回顾性研究。纳入2014年9月—2017年9月唐山市第二医院创伤骨科收治的合并尺骨干经尺骨鹰嘴骨折并肘关节前脱位患者21例,其中男13例、女8例,年龄36~64岁(平均50.5岁)。患者均采用尺骨鹰嘴锁定钢板及重建钢板联合克氏针张力带钢丝内固定术治疗,术后给予抗感染和消肿治疗。术后定期拍摄肘关节正侧位X线片,观察骨折愈合及内固定情况;观察患者肘关节屈伸活动度及前臂旋前旋后角度;术后12个月,采用Broberg-Morrey评分评价患肢功能。结果21例患者手术均顺利完成。术后均获得随访,随访时间为12~24个月,平均16.5个月。患者均获得骨性愈合,骨折愈合时间为2~4个月(平均3.1个月)。随访期间患者无感染、医源性神经损伤、骨折不愈合、内固定断裂失效、肘关节脱位等并发症发生。术后12个月Broberg-Morrey评分为78~100(90.0±5.5)分,患肢功能优12例、良7例、可2例,优良率为90.5%。结论双钢板联合克氏针张力带钢丝内固定治疗合并尺骨干经尺骨鹰嘴骨折并肘关节前脱位,骨折愈合率高,肘关节功能恢复良好。

Objective This study aimed to investigate the clinical experience and outcomes of osteosynthesis of the proximal ulnar metaphysis fracture associated with trans-olecranon anterior fracture dislocation of the elbow.Methods This study retrospectively analyzed 21 patients with proximal ulnar metaphysis fracture associated with trans-olecranon anterior fracture dislocation of the elbow who were admitted from September 2014 to September 2017 in the Orthopaedic Trauma Department of the Second Hospital of Tangshan.The data of patients were as follows:13 males and 8 females,aged 36 to 64(mean,50.5)years.All patients were treated with two osteosynthesis plating and Kirschner wire fixation with tension band wiring for the trans-olecranon anterior fracture dislocation.The patients were given anti-inflammatory and symptomatic treatment after operation.Clinical examination included assessment of the active range of motion of the elbow.At follow up of 12 months,overall outcome was determined on the basis of the scoring system described by Broberg-Morrey.Results All of the 21 patients were followed up from 12 months to 24 months(on average of 16.5 months).All patients obtained good fracture union.The mean time of the fracture union was 3.1 months(range,2-4).No osteomyelitis,iatrogenic nerve injury,nonunion,metal failure,and elbow dislocation occurred until 12-month follow-up.At 12-month follow-up postoperatively,the Broberg-Morrey score was 90(range,78-100).The Broberg-Morrey score was shown as follows:12 cases excellent,7 cases good,and 2 cases fair.Conclusion The treatment with two osteosynthesis plating and Kirschner wire fixation with tension band wiring for the proximal ulnar metaphysis fracture associated with trans-olecranon anterior fracture dislocation of the elbow are effective.It could obtain high fracture union and good elbow function.