尺桡骨近端粉碎骨折伴肘关节后脱位的治疗(1)
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【摘要】 目的探讨尺桡骨近端粉碎骨折伴肘关节后脱位的治疗方法和疗效。方法 尺桡骨近端粉碎骨折伴肘关节后脱位患者30例,男23例,女7例;年龄18~52岁,平均年龄30岁。采用钢板螺钉内固定治疗,其中一期植骨20例。桡骨小头骨折部分,如骨折粉碎不严重,复位后用克氏针固定,并修补环状韧带;如骨折粉碎严重,则行人工桡骨头置换,同时取自体掌长肌腱重建环状韧带。尺骨冠突骨折部分,选用克氏针或拉力螺钉固定骨折块,同时探查尺侧副韧带前束,如损伤予以修复或重建;如合并尺骨鹰嘴骨折,采用钢板螺钉内固定治疗。结果 患者伤口均一期愈合,骨折愈合率为100%。术后随访10~48个月,平均29个月。5例有创伤性关节炎表现,2例发生轻度创伤性骨化。肘关节平均屈伸范围100°~110°,前臂平均旋转活动范围为90°~100°。按照Morrey等肘关节功能评分标准进行评价:优12例,良15例,可2例,差1例,总优良率为90%。结论 治疗尺桡骨近端粉碎骨折伴肘关节后脱位可采用钢板螺钉固定尺桡骨近端骨折,必要时行一期植骨,注意对桡骨,尺骨冠突骨折及肘关节侧副韧带损伤的治疗,以防止肘关节不稳定。
【关键词】尺骨近端骨折;桡骨头骨折;肘关节后脱位;骨折内固定
Treatment in the comminute fracture of proximal ulna and radial associated with the elbow posterior dislocation
Li Qiang, Zhou Zhi-Gang, Yan Zhao-Hua, et al. Department of orthopaedics, The First people’s hospital of jiujiang, Jiang Xi 332000, China
【Abstract】 Objective To investigate the surgical management of the proximal ulna and radial comminuted fractures associated with the elbow posterior dislocation and evaluate the clinical outcome. Methods From January 2000 to October 2007, 30 patients with proximal ulna and radial comminuted fractureds associated with the elbow posterior dislocation were treated,which involced 23 males ang 7 females with an average age of 30 years. All patients were treated with the plate and screw fixation.Bone graft had been done in 20 patients during the primary procedure. For radial head fractured, the internal fixation was performed or radial head replacement. For the ulna coronoid process fractures, internal fixation were performed and repaired the anterior bundle of the ulnar collateral ligaments. Results The mean time of the follow-up was 29 months.The union rate was 100%. No inflammation, neural injuries and elbow instability occurred. Traumatic osteoarthritis occurred 5 cases,and mild heterotopic ossification occurred in 2 cases. The mean range of motion of the afected elbow joint was 100°~110°,and the ROM of forearm rotation was 90°~100°. According to Morrey's evaluation method, 12 patients was classified in excellent, 15 in good, 2 in fair and 1 in poor. The excellent a good rate was 90%. Conclusion Elbow stability must be restored by addressing the specific compinents in the injury. The proximal ulna must be anatomically reduced and internally fixed; the radial head and substantial coronoid fractures must be repaired or reconstructed ......
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