手术治疗尺骨鹰嘴撕脱骨折伴桡骨头骨折的效果分析

Surgical treatment of ulnar olecranon avulsion fracture complicated with radial head fracture

目的探讨手术治疗尺骨鹰嘴撕脱骨折伴桡骨头骨折的临床疗效。方法回顾性分析2016年7月至2022年2月期间北京积水潭医院创伤骨科收治的13例尺骨鹰嘴撕脱骨折伴桡骨头骨折患者资料。男9例,女4例;主力侧6例,非主力侧7例;年龄(38.1±11.7)岁;桡骨头骨折Mason分型:Ⅰ型1例,Ⅱ型1例,Ⅲ型11例。所有患者均采用手术治疗,且优先处理桡骨头骨折。桡骨头骨折的治疗方式:10例患者采用切开复位内固定,3例患者采用桡骨头置换治疗;尺骨鹰嘴撕脱骨折的治疗方式:11例患者行肌腱止点修复,2例患者仅行肌腱修复。末次随访时记录患者的肘关节活动度,并应用Mayo肘关节功能评分(MEPS)、疼痛视觉模拟评分(VAS)、上肢功能评定量表(DASH)分别评定肘关节功能、疼痛和主观上肢功能情况,同时记录随访期间并发症的发生情况及二次手术情况。结果13例患者术后获(37.6±18.5)个月随访。末次随访时13例患者的患侧肘关节屈伸活动度为102.3°±19.6°,范围值为70°~130°;旋前-旋后活动度为149.6°±20.0°,范围值为110°~170°。并发症:桡骨头骨折不愈合1例,肘关节僵硬3例,尺神经功能障碍1例。术后共有3例患者行4次手术。末次随访时13例患者的MEPS评分为100.0(85.0,100.0)分,范围值为75~100分,其中优9例,良4例;疼痛VAS评分为0.0(0.0,2.0)分,范围值为0~3分;DASH评分为2.5(1.3,8.3)分,范围值为0~21分。结论尺骨鹰嘴撕脱骨折合并桡骨头骨折较少见,正确的识别和诊断对这种损伤至关重要,手术治疗可以取得良好的效果。

Objective To evaluate the surgical treatment of ulnar olecranon avulsion fracture complicated with radial head fracture.Methods A retrospective study was conducted to analyze the clinical data of 13 patients who had been treated at Department of Traumatology and Orthopedics,Beijing Jishuitan Hospital for ulnar olecranon avulsion fracture complicated with radial head fracture from July 2016 to February 2022.There were 9 males and 4 females with an age of(38.1±11.7 years),and 6 cases on the dominant side and 7 cases on the non-dominant side.According to Mason classification of radial head fractures,there were 1 case of typeⅠ,1 cases of typeⅡand 11 cases of typeⅢ.All patients were treated surgically and their radial head fractures were prioritized.For radial head fractures,10 patients were treated with open reduction and internal fixation,and 3 patients with radial head replacement.For ulnar olecranon avulsion fractures,11 patients were treated with repair of tendon insertions,and 2 patients with tendon repair only.At the last follow-up,the elbow mobility was recorded,and Mayo elbow performance score(MEPS),visual analogue scale(VAS)for pain,and Disabilities of the Arm,Shoulder and Hand(DASH)scoring were applied to assess the elbow function,pain,and subjective upper extremity function.Complications and secondary surgeries were also followed up.Results The 13 patients were followed up for(37.6±18.5)months after operation.At the last follow-up,the flexion and extension was 102.3°±19.6°(from 70°to 130°),and the pronation-supination was 149.6°±20.0°(from 110°to 170°).Nonunion of the radial head fracture occurred in 1 patient,stiffness of the elbow in 3 patients,and ulnar nerve dysfunction in 1 patient.A total of 4 secondary surgeries were performed in 3 patients.At the last follow-up,in the 13 patients,the MEPS score was 100.0(85.0,100.0)points with a range from 75 to 100 points;the VAS score was 0.0(0.0,2.0)point with a range from 0 to 3 points;the DASH score was 2.5(1.3,8.3)points with a range from 0 to 21 points.Conclusions As ulnar olecranon avulsion fracture complicated with radial head fracture is not common,timely identification and clear diagnosis of such injury is very important.Surgical treatment may result in fine outcomes.