尺骨冠状突骨折手术治疗的回顾性研究
发布时间：2018-08-11 15:57
【摘要】：背景:生物力学及临床性研究均已证明冠状突是肘关节稳定性的重要组成部分。冠状突是阻止尺骨向后侧移位的前方支撑,同时冠状突亦是肘关节前方关节囊及内侧副韧带前束的附着点,冠状突的骨性结构及周围韧带组织的完整性均对肘关节的稳定是重要的。此类损伤应获得手术治疗。对于冠状突骨折手术治疗方案,因其解剖位置的复杂性及特殊性,在显露冠状突的最佳手术入路上尚无统一的意见及方案。目的:回顾性研究吉林大学中日联谊医院尺骨冠状突骨折手术治疗的临床疗效分析,探讨尺骨冠状突骨折的手术入路的选择方案,内固定物的应用,以及术后患者康复情况。方法:选择2014年至2016年吉林大学中日联谊医院诊治的尺骨冠状突骨折患者17例,男15例,女2例;年龄22~47岁,平均33.5岁;左侧13例,右侧4例;致伤原因:高处坠落伤5例,跌倒4例,车祸伤7例。尺骨冠状突骨折块根据O’Driscoll分型,行相应的手术治疗17例,其中,螺钉固定7例,钢板固定10例。通过肘关节前侧入路切口来显露冠状突,同时探查及修复内侧副韧带及关节囊。对所有患者均定期予以术后随访,全部病例平均随访约14.11个月。在末次随访过程时,观察并测量肘关节的屈伸及旋前、旋后活动度,用MAYO(Mayo elbow performance score)肘关节功能评分系统来评价患者肘关节功能恢复情况。结果:所有在本回顾性研究中患者均随访8~23个月,平均时间达到14.1个月左右,随访患者切口均愈合,无感染情况,术后骨折全部获得临床愈合,平均愈合时间12周左右,手术患者根据Mayo评分评价,优9例,良8例,中0例,差0例。数据整理后,根据骨折类型Ⅰ型,Ⅱ型,Ⅲ型,分别将肘关节活动范围与健侧相比较,采用x±s,组间配对t检验,计算P值,有意义的标准为P0.05。肘关节活动度详见表。平均MEPS评分为92.5分,所有患者的肘关节功能恢复良好,恢复其稳定性。结论:通过对吉林大学中日联谊医院的17例患者的回顾性分析,并查阅国内外文献,可以得出下列结论:1、大部分尺骨冠状突骨折患者需手术治疗,恢复肘关节的解剖结构,修复损伤的内、外侧副韧带。术后医师指导下进行有效、合理的功能练习,有利于术后肘关节功能恢复。2、冠状突骨折手术治疗中,肘关节前侧入路具有显露充分,安全系数高,损伤较小,利于肘关节功能恢复,临床效果满意。3.选择合适内固定物对于骨折复位及术后功能练习具有重要意义。
[Abstract]:Background: the coronal process has been proved to be an important component of elbow stability in biomechanical and clinical studies. The coronal process is the front support to prevent the ulna from moving to the posterior side, and the coronal process is also the attachment point of the anterior articular capsule and the anterior bundle of medial collateral ligament of the elbow joint. The osseous structure of the coronal process and the integrity of the surrounding ligaments are important for the stability of the elbow joint. Such injuries should be treated surgically. Because of the complexity and particularity of the anatomical location, there is no uniform opinion and scheme on the best surgical approach to expose the coronal process for the surgical treatment of coronal process fracture. Objective: to study retrospectively the clinical curative effect of surgical treatment of ulnar coronoid process fracture in Sino-Japanese Friendship Hospital of Jilin University, and to discuss the choice of operative approach, the application of internal fixation, and the postoperative rehabilitation of the patients with ulnar coronal process fracture. Methods: from 2014 to 2016, 17 patients (15 males and 2 females) with fracture of the ulna coronal process, aged 2247 years (mean 33.5 years), left side (13 cases) and right side (4 cases), were selected and treated by Sino-Japanese Friendship Hospital of Jilin University. 4 cases fell and 7 cases were injured in traffic accident. According to O'Driscoll classification, 17 cases of ulnar coronal process fracture were treated with screw fixation in 7 cases and plate fixation in 10 cases. The coronal process was exposed through the anterior approach of elbow joint, and the medial collateral ligament and joint capsule were explored and repaired. All patients were followed-up regularly, all patients were followed up for an average of 14.11 months. During the last follow-up, the flexion, extension, pronation and pronation of elbow joint were observed and measured. The functional recovery of elbow joint was evaluated by MAYO (Mayo elbow performance score) elbow function scoring system. Results: all the patients were followed up for 8 ~ 23 months, the average time was about 14.1 months. All the patients were healed without infection, and all the fractures were healed clinically, the average healing time was about 12 weeks. According to Mayo score, 9 cases were excellent, 8 cases were good, 0 cases were moderate and 0 cases were poor. According to the fracture type 鈪，
本文编号：2177465
[Abstract]:Background: the coronal process has been proved to be an important component of elbow stability in biomechanical and clinical studies. The coronal process is the front support to prevent the ulna from moving to the posterior side, and the coronal process is also the attachment point of the anterior articular capsule and the anterior bundle of medial collateral ligament of the elbow joint. The osseous structure of the coronal process and the integrity of the surrounding ligaments are important for the stability of the elbow joint. Such injuries should be treated surgically. Because of the complexity and particularity of the anatomical location, there is no uniform opinion and scheme on the best surgical approach to expose the coronal process for the surgical treatment of coronal process fracture. Objective: to study retrospectively the clinical curative effect of surgical treatment of ulnar coronoid process fracture in Sino-Japanese Friendship Hospital of Jilin University, and to discuss the choice of operative approach, the application of internal fixation, and the postoperative rehabilitation of the patients with ulnar coronal process fracture. Methods: from 2014 to 2016, 17 patients (15 males and 2 females) with fracture of the ulna coronal process, aged 2247 years (mean 33.5 years), left side (13 cases) and right side (4 cases), were selected and treated by Sino-Japanese Friendship Hospital of Jilin University. 4 cases fell and 7 cases were injured in traffic accident. According to O'Driscoll classification, 17 cases of ulnar coronal process fracture were treated with screw fixation in 7 cases and plate fixation in 10 cases. The coronal process was exposed through the anterior approach of elbow joint, and the medial collateral ligament and joint capsule were explored and repaired. All patients were followed-up regularly, all patients were followed up for an average of 14.11 months. During the last follow-up, the flexion, extension, pronation and pronation of elbow joint were observed and measured. The functional recovery of elbow joint was evaluated by MAYO (Mayo elbow performance score) elbow function scoring system. Results: all the patients were followed up for 8 ~ 23 months, the average time was about 14.1 months. All the patients were healed without infection, and all the fractures were healed clinically, the average healing time was about 12 weeks. According to Mayo score, 9 cases were excellent, 8 cases were good, 0 cases were moderate and 0 cases were poor. According to the fracture type 鈪，
本文编号：2177465
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