尺骨冠突前内侧关节面骨折合并肘关节脱位/半脱位(附2例报告)

[目的]介绍"尺骨冠突前内侧关节面骨折合并肘关节后脱位/内旋半脱位"的新概念.[方法]自2005年1月～2006年12月收治2例患者,其损伤特征包括:肘关节后脱位或内旋半脱位;冠突前内侧关节面劈裂骨折呈倒立三角形,连带内侧副韧带前束的附着点高耸结节,为O'Driscoll Ⅱ型;外侧副韧带从起点撕脱.治疗上采用肘关节内、外侧入路,分别固定骨折和修复韧带,并随访1年以上.[结果]肘关节无疼痛和不稳,屈伸和旋转幅度与健侧相同,恢复伤前体力工作.MEPS评分和DASH评分均为优.[结论]认识这一新的肘关节损伤类型,并手术固定骨折和修复韧带,能获得优良的功能效果.     

尺骨冠突前内侧面骨折研究进展

尺骨冠突在肘关节稳定性中的作用越来越受到重视.解剖研究发现约有58%的尺骨冠突前内侧面没有尺骨干骺端和骨干的支持,受到内翻应力极易发生骨折.肘关节内翻、后内侧旋转损伤可引起冠突前内侧面骨折,常伴有肱尺关节半脱位和外侧副韧带起点处撕脱损伤.肘内侧副韧带前束不易受损.常表现为完整的内侧副韧带前束连带着前内侧面骨折块,一般骨折块较大,可引起肘关节内侧不稳.目前此类骨折以手术治疗为主,可先行肘内侧入路暴露骨折处,直视下解剖复位和牢固固定骨折块,再通过肘后外侧入路修复受损的外侧副韧带.重建冠突稳定性和修复受损的外侧副韧带可使肘关节获得稳定,并达到满意的治疗效果.但该法主要适用于单纯冠突前内侧面骨折,如果骨折是肘部复杂骨折脱位的一部分,可根据骨折类型选择合适的手术入路和固定方法.     

前内侧面尺骨冠状突骨折的手术治疗策略

目的:探讨手术治疗前内侧面尺骨冠状突骨折的手术入路选择、内固定方法及其疗效。方法:自2005年3月至2010年3月,采用手术内固定治疗前内侧面冠突骨折18例,男12例,女6例;年龄19～74岁,平均37.8岁。全部采用切开复位内固定治疗。取肘后正中切口,游离皮瓣后在外侧暴露肘关节外侧副韧带复合体及关节囊,采用不可吸收线缝合法或锚钉技术修复外侧副韧带复合体。根据术前三维重建图像上骨折情况及分型,分别选择3个不同的手术入路,暴露前内侧面冠状突骨折,采用微型钢板及螺钉固定。用MEPS(Mayo elbow performance score)和Broberg&Morrey评分对肘关节功能进行评价。结果:17例获得随访,时间1～6年,平均38个月;骨折均获临床愈合,愈合时间8～16周,平均11.6周。末次随访时,所有患者肘关节没有明显疼痛及不稳定。MEPS评分82～100分,平均(95.4±4.6)分;Broberg&Morrey评分75～100分,平均(92.3±5.8)分。结论:切开复位微型钢板内固定可使前内侧面冠状突骨折达到良好的解剖复位及坚强固定,是治疗前内侧面尺骨冠突骨折的有效方法。     

尺骨冠状突前内侧面骨折伴肘关节外侧副韧带损伤的手术治疗

目的探讨尺骨冠状突前内侧面骨折伴肘关节外侧副韧带损伤的手术治疗方法及临床疗效。 方法回顾性分析2011年4月至2014年7月四川省骨科医院收治且获完整随访的9例尺骨冠状突前内侧面骨折伴肘关节外侧副韧带损伤患者临床资料。其中男6例,女3例;年龄20~62岁,平均41岁。致伤原因：跌伤3例,自行车伤1例,电动自行车伤3例,交通事故伤2例。均为新鲜闭合骨折;无神经、血管损伤。受伤至手术时间4~12 d,平均7.2 d。均为O'Driscoll分型2型,其中1亚型1例,2亚型5例,3亚型3例。其中肘关节外侧副韧带肱骨外髁止点撕脱骨折4例,其余5例术中证实肘关节外侧副韧带肱骨外髁止点撕脱。伴有尺骨鹰嘴骨折或为肘关节恐怖三联征患者未纳入本组。经肘关节前侧或内侧入路复位,以支撑钢板、缝合锚、螺钉固定冠状突骨折及修复前侧关节囊。经后外侧入路,以缝合锚修复外侧副韧带。 结果术后切口均Ⅰ期愈合,无血管神经损伤。随访时间12~48个月,平均25.6个月,X线片示骨折均愈合。随访期间无内固定物失效、肘关节不稳定、创伤后骨关节炎等并发症发生。末次随访时患肘关节活动范围：伸肘0~10°,平均1.1°;屈肘110~135°,平均128.9°;前臂旋前40~70°,平均61.1°;旋后80~90°,平均88.9°。Broberg和Morrey肘关节功能评分为82~100分,平均95分;优6例,良3例,优良率100%。疼痛视觉模拟评分为0~2分,平均0.7分。 结论重视和识别尺骨冠状突前内侧面骨折伴肘关节外侧副韧带损伤,对于存在肘关节内翻后内侧旋转不稳定者,根据冠状突骨折块的大小、部位及形态,经肘关节前侧或内侧入路复位,以支撑钢板、缝合锚及螺钉固定,修复前侧关节囊,经肘关节后外侧入路,以缝合锚修复外侧副韧带,术后早期活动锻炼,可获得满意疗效。     

单一外侧入路治疗肘部损伤"三联征"的修复技巧及疗效分析

目的 探讨采用单一肘关节外侧入路治疗肘部损伤"三联征"的手术扩大显露、修复技巧及临床疗效.方法 对2007年5月至2010年3月收治的6例肘部损伤"三联征"患者采用单一肘关节外侧入路,由深至浅依次修复下列结构:冠状突骨折、桡骨头骨折、外侧副韧带、伸肌总腱起点.并用自创的方法对冠状突骨折进行扩大显露,直视下复位与牢靠固定,对肘关节外侧结构的撕裂进行有效修复.本组患者均未做肘关节内侧副韧带的探查与修复.随访时采用Mayo肘关节功能评分(MEPS)对患者肘关节功能进行评价.结果 本组患者随访3～24个月,平均11个月.所有患者骨折均获骨性愈合,肘部屈伸活动度105°～135°,平均120.0°;前臂旋转活动度150°～170°,平均168.3°;MEPS评分93～95分,平均93.3分,均为优.所有患者均无伤口感染,伤口一期愈合.结论 单一肘关节外侧入路结合相应手术技巧的改进,解决了肘部损伤"三联征"中冠状突骨折复位与固定的疑难问题,对肘关节外侧结构的修复也更加简单、牢靠,是一种临床可行且疗效满意的手术方式.     

单纯外侧入路手术治疗肘关节恐怖三联征

目的探讨单纯外侧入路内固定治疗肘关节"恐怖三联征"的手术技巧及临床疗效。方法回顾性分析自2004-01—2016-12诊治的21例肘关节"恐怖三联征",均采用外侧入路手术,尺骨冠状突骨折及桡骨头骨折均用无头挤压螺钉内固定,撕裂的外侧副韧带用带线锚钉修复重建。结果 21例均获得随访,随访时间平均31.6(12~72)个月。骨折愈合时间10~16周,平均12周。末次随访时所有患者肘关节屈伸、旋转活动及内外翻应力时肘关节均保持稳定,屈伸活动范围均可达到15°~130°,旋转活动度平均140°。末次随访时肘关节功能MEPS评分平均89(75~100)分,其优8例,良11例,可2例。结论单纯外侧入路手术治疗肘关节"恐怖三联征"可取得满意的疗效,尺骨冠状突骨折、桡骨头骨折固定及修复外侧副韧带后,肘关节已经获得相对稳定,无需作内侧切口修复内侧副韧带。     

肘关节内翻-后内侧旋转不稳定的临床特点及康复方案

目的探讨肘关节内翻-后内侧旋转不稳定的临床特点及康复方法。方法回顾性分析自2013年9月至2016年4月收治的外伤致肘关节复杂脱位45例,选取其中内翻-后内侧旋转不稳定9例,男4例,女5例;年龄19~55岁,平均35岁;7例摔伤,2例高坠伤,均为闭合性损伤。均采用肘关节前内侧旋前圆肌与桡侧腕屈肌间隙入路,使用克氏针、经尺骨近端套索缝合、带线锚钉套索缝合、空心螺钉、微型钢板等固定冠突骨折块,对于冠突粉碎者取自体髂骨重建冠突、钢板固定,同时修复尺侧副韧带,若术中肘关节仍不稳定或伴有肱骨外上髁骨折,可行外侧Kocher入路带线锚钉修复桡侧副韧带,空心螺钉或钢板修复肱骨外上髁,伴有下尺桡关节不稳的可闭合复位,克氏针经皮固定6周,随访12~24个月,按照Mayo肘关节功能评分系统对肘关节功能进行评估。结果本组9例均获得随访,随访时间12~24个月,平均16个月,X线复查示冠突及肱骨外上髁骨折均骨性愈合,未发现内固定失效,肘关节结构正常、稳定,2例出现不同程度的骨化性肌炎,2例诉肘关节晨起时麻木、疼痛,活动后症状缓解。按Mayo肘关节功能评分系统评定,优6例,良2例,可1例。结论肘关节内翻-后内侧旋转不稳定是由后倒手撑地受伤,肘关节受到轴向、内翻、旋前暴力所致,肘关节较外翻-后外侧旋转不稳型更不稳定,易复发脱位,采用前内侧入路固定冠突、修复内侧副韧带前束,必要时使用Kocher入路修复桡侧损伤结构,早期康复方案,可使肘关节功能恢复良好。     

外侧入路联合前内侧入路治疗肘关节“恐怖三联征”的手术疗效

 目的 探讨采用外侧入路联合前内侧入路治疗肘关节“恐怖三联征”的手术疗效。方法 回顾性分析2008年7月至2011年1月,采用外侧入路联合前内侧入路治疗23例肘关节“恐怖三联征”患者,其中21例获得完整随访资料,男17例,女4例;年龄17~63岁,平均38.4岁;坠落伤15例,运动损伤4例,交通伤2例;受伤至手术时间为2~8 d,平均4 d。尺骨冠突骨折O’Driscoll分型：A1型5例,A2型12例,B2型4例;桡骨头骨折Mason分型：Ⅰ型2例,Ⅱ型12例,Ⅲ型7例;软组织损伤仲飙等分型：Ⅰ型6例,Ⅱ型12例,Ⅲ型3例。先采用Kocher入路内固定或人工桡骨小头置换治疗桡骨小头骨折,暂时修补外侧副韧带复合体,而后通过前内侧入路固定冠突骨折并修补内侧副韧带损伤;术后采用铰链式外固定支具辅助固定。术后分别采用Mayo肘关节评分（Mayo elbow performence score, MEPS）和Broberg-Morrey分级评估患者肘关节功能及创伤性关节炎程度。结果 21例患者均获得随访,随访时间24~48个月,平均32个月。末次随访时,患者肘关节屈伸及前臂旋转平均活动度分别为126°（范围,115°~135°）和139°（范围,125°~145°）;MEPS评分为85~100分,平均95分,其中19例评定为优,2例为良,优良率为100%,无一例发生肘关节复发不稳定。术后1周,1例发生伤口浅表感染,经清创及静脉使用抗生素治疗后愈合;术后3个月,发生异位骨化症2例,桡骨头骨折骨不连1例,尺神经麻痹1例,均未行手术处理。结论 采用外侧入路联合前内侧入路治肘关节“恐怖三联征”具有一期同时重建骨结构和恢复软组织稳定性的优势,术后患者能早期进行功能锻炼,利于肘关节功能恢复。     

肘关节创伤中内侧副韧带重建必要性之辩

肘关节创伤中内侧副韧带结构损伤较为常见。内侧副韧带复合体分为前、斜、后三束,前束起始于肱骨内侧髁的前下部,止于尺骨冠突的前内缘。斜束紧贴尺骨面,连续前束和后束在尺骨上的止点。后束起于肱骨内侧髁的内下缘,止于尺骨鹰嘴近中1/3内缘。2009年肘关节恐怖三联征治疗指南中治疗肘关节恐怖三联征应常规行外侧副韧带修复,是否需要修复内侧结构（包括内侧副韧带及共同屈肌复合体）是争论焦点。肘关节恐怖三联征损伤不一定都损伤外侧副韧带,也有可能仅损伤内侧副韧带。内侧副韧带前束在抗外翻应力方面起主要作用,是肘关节内侧稳定的主要结构。内侧副韧带前束是肘关节韧带中最坚韧的一束,从肘关节伸直到屈曲60°的过程中呈紧张状态;屈曲超过60°,在抗外翻应力方面前、后束共同起作用。Eygendaal等通过长期随访发现,大部分内侧副韧带损伤的患者都存在肘关节外翻不稳定相关性疾病,如关节退化、异位骨化、疼痛等,因此认为应该对存在内侧副韧带损伤的患者进行MCL修复。Jeong等对13例肘关节恐怖三联征患者在对修复肘关节外侧的同时,常规通过外侧入路或内侧入路修复内侧受损结构,平均随访25个月,Mayo评分为平均95分（85~100分）,获优10例,良3例。他们认为采用内、外侧入路修复所有内、外侧损伤组织可达到满意的临床及影像学效果,建议对于肘关节恐怖三联征患者应常规修复关节内侧结构。Toros等认为一般仅对外侧结构修复完毕后仍存在持续性肘关节屈伸不稳定或明显外翻不稳定的患者,应采取内侧入路修复内侧结构。     

肘关节三联征的诊断和治疗进展

肘关节三联征是一种复杂的肘关节骨折脱位,复位后肱尺关节和肱桡关节可达到同心圆复位、肘关节稳定,桡骨及冠突骨折块较小可保守治疗,但需定期复查。若需手术治疗,必须修复桡骨头骨折及外侧副韧带复合体。可以采用单一外侧入路也可以联合前内侧入路。MorryⅠ型和Ⅱ型冠状突骨折是否需固定,是否附加外固定支架固定及同时修复内侧副韧带损伤仍存在争议。     

Anteromedial coronoid facet fractures

The anteromedial coronoid facet and the medial lip of trochlea represent one of the most important stabilizing columns of the elbow to prevent posterior dislocation of the elbow. But on average, 58 % of the anteromedial facet extends from the proximal ulnar without sufficient support by the proximal ulnar metaphysic. Some important soft tissue structures insert on the coronoid process. The fracture of anteromedial coronoid facet was recognized recently in clinic as a distinct type of the coronoid fracture. The special injury mechanism is varus posteromedial rotational injury force. This mechanism results in fracture of the anteromedial facet of the coronoid process most often associated with injury of the lateral collateral ligament (LCL) and either subluxation or complete dislocation of the elbow. But the anterior band of the medial collateral ligament is likely to be intact in the complex pattern injury. Standard radiographic evaluation of the fracture includes AP and lateral views of the elbow. Computed tomography, particularly 3D reconstruction, is particularly useful to diagnose the injury. But the LCL injury is easy to be missed, resulting in an earlier traumatic arthrosis. So, it is very important to increase recognition to the pattern injury. If the single distinct converse triangular fragment be found from the film, the surgeon should take care highly, and varus stress x-ray should be necessary to evaluate the LCL injury. Early experience suggests that the injuries should benefit from operative treatment. All injured structures should be repaired to restore the stability of the elbow. Intraoperative testing of the elbow stability is very important.     

Fracture of the anteromedial facet of the coronoid process

BACKGROUND: Fracture of the anteromedial facet of the coronoid was recently recognized as a distinct type of coronoid fracture resulting from a varus posteromedial rotational injury force. Very few reports are available to help guide the management of these injuries. METHODS: Eighteen patients with a fracture of the anteromedial facet of the coronoid process were treated over a six-year period. Twelve patients were treated for the acute fracture, and six were managed after initial treatment elsewhere. All but three patients (two with concomitant fracture of the olecranon and one with a second fracture at the base of the coronoid) had avulsion of the origin of the lateral collateral ligament complex from the lateral epicondyle. The initial treatment was operative in fifteen patients and nonoperative in three. The coronoid fracture was secured with a plate applied to the medial surface of the coronoid in nine patients, a screw in one patient, and sutures in one patient. It was not repaired in the remaining seven patients. RESULTS: At the final evaluation, an average of twenty-six months after the injury, six patients had malalignment of the anteromedial facet of the coronoid with varus subluxation of the elbow, which was due to the fact that the fracture had not been specifically treated in four patients and to loss of fracture fixation in two patients. All six had development of arthrosis and a fair or poor result according to the system of Broberg and Morrey. The remaining twelve patients had good or excellent elbow function. CONCLUSIONS: Anteromedial fractures of the coronoid are associated with either subluxation or complete dislocation of the elbow in most patients. Secure fixation of the coronoid fracture usually restores good elbow function.     

(iii) Elbow instability, mechanism and management

Acute dislocations of the elbow without significant fracture are classified as simple. In all cases the medial and lateral ligaments are avulsed, usually as an osteo-periosteal sleeve. The majority are stable on reduction and immediate active mobilisation is encouraged. The incidence of recurrent dislocation and instability is very low. Acute dislocations associated with significant fractures are classified as complex. The most common associated fractures are of the radial head or coronoid process, and if both fractures are present this is termed the “terrible triad”. The principle of management is reduction of the joint, anatomical fixation of the fracture fragments, with repair or reconstruction of ligaments if indicated. If the elbow remains unstable, or if fracture or fixation or ligament repair is tenuous, then the use of a hinged external fixator is recommended.The most common type of chronic instability is postero-lateral rotatory instability, which is related primarily to incompetence of the lateral ulnar collateral ligament. Conservative treatment is rarely successful and most require a reconstruction of the lateral ulnar collateral ligament with a graft. Medial instability is predominantly seen in throwing athletes with chronic stretch of the medial ligament that interferes with throwing capacity. If conservative management fails then the anterior bundle of the medial collateral ligament can be reconstructed with a tendon graft.     

肘前内侧切口入路手术治疗尺骨冠状突前内侧面骨折

目的:探讨尺骨冠状突前内侧面骨折手术治疗入路和合并损伤的处理。方法:自2009年7月至2011年8月,共收治尺骨冠状突前内侧面骨折6例,男4例,女2例;年龄19～49岁,平均32.6岁;左侧3例,右侧3例;优势侧4例,非优势侧2例;均为闭合性骨折。根据O’Driscoll尺骨冠状突骨折分型均为冠状突前内侧面骨折2亚型或3亚型,均采用肘前内侧切口桡侧腕屈肌和掌长肌之间劈开指浅屈肌入路行微型接骨板固定,其中3例行冠状突固定后肘关节内翻应力位X线检查可见肱桡间隙增宽,表现出肘关节内翻后内侧旋转不稳定,桡侧副韧带未进行探查修复。术后石膏固定2周行肘关节功能锻炼,表现出内翻后内侧旋转不稳定者石膏固定4周。术后随访记录患者肘关节活动范围、疼痛和稳定情况,肘关节力量和手部握力,根据改良An和Morrey肘关节功能评分评价肘关节总体功能。结果:6例术后均获随访,时间7.5～13个月,平均9.3个月。患侧肘部和手部力量均同健侧,肘关节平均屈曲(129.0±6.5)°(120°～135°),平均伸直(4.0±4.2)°(0°～10°),前臂旋转活动度平均旋前(84.0±6.5)°(75°～90°),平均旋后(89.0±7.1)°(80°～100°),1例术后出现尺神经感觉症状并于半年后恢复,所有患者未出现肘关节疼痛、不稳定,改良An和Morrey肘关节功能评分均为优。结论:尺骨冠状突前内侧面骨折可采用桡侧腕屈肌和掌长肌间入路进行切开复位内固定治疗,伴肘关节内翻-后内侧旋转不稳定者可适度延长制动时间。     

Treatment of fractures of the ulnar coronoid process

Objective: To discuss the classification, management and outcome of fractures of the ulnar coronoid process. Methods: Retrospective analysis was carried out in 31 patients (19 men and 12 women of average age 29.8 years [range, 18–52 years]) with fractures of the ulnar coronoid process. The fractures were classified into four major groups based on the extent of injury to the ulnar coronoid process, the state of the anterior bundle of the ulnar collateral ligaments (UCL) and elbow stability. A fracture of the coronoid process less than halfway up was defined as type I (eleven cases); of the middle of the coronoid process with injury of the UCL as type II (nine cases); of the base of coronoid process with dislocation of the elbow joint, sometimes with injury of the UCL, as type III (six cases); and severe comminuted fracture of the coronoid process with elbow instability as type IV (five cases). We chose treatment according to the type of injury. Results: Follow‐up was 18–72 months (average 28.6 months). All patients achieved fracture union without inflammation, neural injuries or elbow instability. One type III and two type IV patients had traumatic osteoarthritis, and two type III and two type IV developed heterotopic ossification. There was a statistically significant difference between the ranges of movement of the two‐side joints in type IV. Conclusion: We choose conservative treatment for type I fractures unless the bone fragment affected movement of the elbow joint, in which case we chose operative treatment so that elbow stability was not affected. Type II and type III fractures with elbow instability were reduced by internal fixation and the ligament repaired or reconstructed. In type IV cases, bone reconstruction was necessary to recover elbow stability. Proper post‐operative rehabilitation can decrease the occurrence of traumatic osteoarthritis.     

Non surgically managed anteromedial coronoid fractures in posteromedial rotatory instability: three cases with 2 years follow-up

Varus posteromedial rotatory instability refers to one of the complex elbow fracture-dislocation caused by anteromedial coronoid fracture with disruption of lateral collateral ligament (LCL). Recent clinical and biomechanical studies have demonstrated that this unstable complex injury resulted in incongruence of joint, which could lead to early posttraumatic arthritis. With reports of poor result after conservative treatment, surgical treatment including anteromedial fixation and LCL repair has been strongly recommended to achieve stable joint. This case series describes three patients with anteromedial coronoid fracture who were managed conservatively with excellent outcomes. This report suggests that anteromedial coronoid fracture associated with posteromedial rotatory instability might be treated using conservative treatment in selective cases when anteromedial coronoid fracture is minimally displaced and there is no evidence of elbow subluxation.     

桡骨远端骨折合并同侧肘关节损伤的手术治疗体会

目的探讨桡骨远端骨折合并同侧肘关节周围骨折或脱位的治疗方法,提高临床治疗效果。 方法回顾性分析本院自2012年1月至2016年10月收治的桡骨远端骨折合并同侧肘关节脱位或骨折病例22例。22例桡骨远端骨折中13例伴尺骨茎突骨折,3例伴尺骨远端骨折,2例伴舟状骨骨折。22例肘关节周围损伤中5例为尺桡骨近端骨折,3例为肱骨远端骨折,14例发生肘关节后脱位。 结果所有患者均获得随访,术后平均随访时间为13.6个月（11~26个月）,所有骨折均愈合,未发生感染。Cooney腕关节评分平均为92.5分（55~100分）,其中优13例、良7例、中1例、差1例。Mayo肘关节功能评分平均为87.5分（50~100分）,其中优10例、良8例、中3例,差1例。其中1例就诊时已出现骨筋膜室综合征,尺神经、正中神经、桡神经均损伤,肌肉部分坏死切除,功能恢复较差。 结论桡骨远端骨折合并同侧肘关节损伤多为高能量损伤,早期积极而恰当的处理能为患者二次手术提供良好的条件,结合积极的康复锻炼,能取得良好的治疗效果。     

桡骨头复杂骨折手术疗效分析

目的研究分析切开复位内固定治疗桡骨头复杂骨折的效果。方法方法2003年3月至2008年6月,我院收治桡骨头复杂骨折共35例,其中男性21例,女性14例;平均年龄32.5岁(18～62岁);受伤至手术平均时间为5.5 d(2～15 d);伴发其他部位损伤11例,包括同侧肱骨小头骨折2例,同侧尺骨近段粉碎性骨折1例,同侧尺骨鹰嘴撕脱性骨折2例,冠状突骨折6例(Regan-Morrey分型Ⅰ型2例,Ⅱ型3例,Ⅲ型1例,需要手术处理3例);根据Mason-Johnston分型,Ⅲ型26例,Ⅳ型9例。采用Kocher切口经肘肌与尺侧腕伸肌之间进入,显露旋后肌保护桡神经深支,骨折复位后以微型钢板结合克氏针固定,探查并修补外尺侧副韧带,部分桡骨颈骨缺损取用肱骨外髁植骨。对伴有冠状突骨折需要手术患者采用前内侧Z形切口复位固定,探查并修补内侧副韧带。对2例配合使用肘关节外固定支架固定,1例术后给予外固定支具保护。结果术后平均随访时间12.6个月(7～24个月),骨折均获得骨性愈合,平均愈合时间5.5个月(3.5～6.5个月)。2例内外侧副韧带附着处出现骨化现象。根据Broberg-Morrey评分进行评定,Mason-JohnstonⅢ型26例中优8例,良14例,可3例,差1例,优良率为85%;Ⅳ型9例中优1例,良3例,可3例,差2例,优良率仅为44%(其中1例优者配合用了外固定支架)。Ⅲ型组疗效明显优于Ⅳ型组,两者差异有统计学意义(P=0.03)。结论对桡骨头复杂骨折,尤其是Ⅲ型患者,应采取切开复位内固定治疗,并对伴有的肘关节韧带损伤进行修补,适时进行植骨术,可取得较为满意的疗效;不应行一期桡骨头切除。对少数Ⅳ型骨折,可采取肘关节外固定支架结合有限内固定治疗或延期桡骨头切除术,但具体疗效还有待进一步观察。     

A figure-eight suture loop with Kirschner wires for fixation of anteromedial coronoid process fractures: A case series

PurposeSufficient fixation of an anterior or anteromedial facet fracture of the coronoid process in fracture-dislocation of elbow is important to maintain joint stability. The purpose of this study was to report our experience with 11 patients who were managed with an original fixation technique using a “figure-eight” suture loop.MethodsFrom February 2010 to March 2011, 11 cases with a fracture of the anterior or anteromedial facet of the coronoid process were treated by coronoid fixation using a figure-eight suture loop. For cases with comminuted fractures, to prevent a suture from sliding into the fracture line, a 3- or 4-hole phalanx plate was enclosed in the suture loop to compress multiple fragments. Accompanying injuries, such as a radial head fracture or olecranon fracture, were fixed with repair of lateral collateral ligament injuries.ResultsOn final evaluations at an average of 18 months after injury, the mean elbow arc of motion was 125.5° and the mean forearm rotation arc of 124.1°. All fractures were united with an average postoperative score according to the Mayo Elbow Performance Index of 91 points. All patients achieved satisfactory scores (seven excellent, four good). All 11 fractures were united at final follow-up with no joint incongruity, dislocation, or subluxation of the injured elbow.ConclusionsThe figure-eight suture loop technique is an easy and effective technique to fix anterior or anteromedial facet fractures of the coronoid process.