尺骨冠状突骨折双柱分型及其临床意义

Double column classification system of ulnar coronoid process fractures and its clinical significance

目的 根据尺骨冠状突内外侧柱的概念提出尺骨冠状突骨折双柱分型,通过临床研究验证该分型的可行性并探讨其临床意义。方法 回顾性分析2012-06—2016-06手术治疗的107例尺骨冠状突骨折,根据“柱”的概念将尺骨冠状突骨折分为内侧柱骨折、外侧柱骨折和双柱骨折,其中外侧柱骨折60例,内侧柱骨折17例,双柱骨折30例。30例外侧柱骨折采用非手术治疗,30例外侧柱骨折进行手术治疗,内侧柱骨折与双柱骨折均采用手术治疗,手术细节根据不同的损伤类型和骨折分型决定。结果 107例均获得随访,随访时间平均20(15~42)个月。手术患者未出现骨折不愈合和内固定失败,骨折愈合时间平均3.5(3~5)个月。末次随访时内侧柱骨折组屈伸弧为(98±15)°,前臂旋转弧为(137±22)°,肘关节功能Mayo评分为(92±7)分。外侧柱骨折组屈伸弧为(107±20)°,前臂旋转弧为(141±18)°,肘关节功能Mayo评分为(95±8)分。双柱骨折组屈伸弧为(95±19)°,前臂旋转弧为(134±16)°,肘关节功能Mayo评分为(89±10)分。末次随访时肘关节功能评定结果:优40例,良37例,可26例,差4例。术后10例肘关节轻度异位骨化但无需手术治疗,7例术后因并发症需进行二次手术。结论 尺骨冠状突骨折双柱分型较O’Driscoll分型简单,较Regan-Morrey分型更强调尺骨冠状突立体概念,为临床医师制定不同治疗策略提供指导,在重视内侧柱稳定、降低术后功能障碍发生率方面具有一定的临床意义。

Objective To propose the double column classification of ulnar coronoid process fractures based on the concept of the medial and lateral columns of the ulnar coronoid process,verify the feasibility of the classification and investigate its clinical significance through clinical studies.Methods A retrospective analysis was made on 107 cases of ulnar coronoid process frac-tures treated by operation from June 2012 to June 2016.According to the concept of“column”,ulnar coronal process fractures were divided into medial column fractures,lateral column fractures and double column fractures.Sixty cases were lateral col-umn fractures,17 cases medial column fractures and 30 cases double column fractures.And 30 cases of lateral column frac-tures were treated by non-operation,30 cases of lateral column fractures were treated by operation,and both medial column fractures and double column fractures were treated by surgical treatment.The surgical details depended on different injury types and fracture types.ResultsAll 107 cases were followed up for an average of 20(range,15-42)months.There was no fracture nonunion and failure of internal fixation,and the average fracture healing time was 3.5(range,3-5)months.At the last follow-up,the flexion and extension arc of the medial column fracture group was(98±15)°,the forearm rotation arc was(137±22)°,and the Mayo score of elbow joint function was(92±7).In the lateral column fracture group,the flexion and extension arc was(107±20)°,the forearm rotation arc was(141±18)°,and the Mayo score of elbow joint function was(95±8).In the double column fracture group,the flexion and extension arc was(95±19),the forearm rotation arc was(134±16)°,and the Mayo score of elbow joint function was(89±10).At the last follow-up,the function of elbow joint was excellent in 40 cases,good in 37 cas-es,fair in 26 cases and poor in 4 cases.After operation,the mild heterotopic ossification of elbow joint occurred in 10 cases but the surgical treatment was not needed,and 7 cases needed secondary operation because of postoperative complications.Conclusion The double column classification of ulnar coronoid process fracture is simpler than Regan-Morrey classification,and emphasizes the three-dimensional concept of ulnar coronoid process more than O'Drislass classification.It provides guidance for clinicians to formulate different treatment strategies,and has certain clinical significance in paying attention to the stability of medial column and reducing the incidence of postoperative dysfunction.