手术治疗肘关节脱位合并尺骨冠状突骨折

目的 探讨手术治疗肘关节脱位合并尺骨冠状突骨折的疗效.方法 手术治疗18例肘关节脱位合并尺骨冠状突骨折患者.记录手术时间、疼痛VAS评分、肘关节活动度、并发症情况及Broberg-Morrey评分.结果 手术时间65～180 min.16例患者获得随访,时间12～24个月;2例失访.术后1例肱桡关节脱位,3例异位骨化,...     

尺骨冠状突骨折的手术治疗

目的探讨尺骨冠状突骨折的手术适应证、入路及内固定方法。方法自1998年1月～2005年1月手术治疗尺骨冠状突骨折患者23例(24侧)。Regan-Morrey分型:Ⅰ型1例,Ⅱ型15例(16侧),Ⅲ型7例。内固定方法:克氏针张力带钢丝及螺丝钉固定各6侧,克氏针加丝线固定3侧,单纯克氏针固定2侧,钢丝环扎固定1侧,骨片摘除5侧,冠状突重建1侧。结果对随访资料完整的20例(21侧)进行9～28个月(平均19个月)的随访,根据肘关节活动范围、疼痛程度、肌力,以及稳定性进行评定疗效:优9侧,良6侧,可3侧,差3侧,优良率71.4%。肘关节半脱位2例,骨化性肌炎2例,无肘关节脱位及肘关节强直等严重并发症。结论Ⅲ型骨折、明显移位及伴有肘关节不稳的Ⅱ型骨折宜采用手术治疗;手术不仅可以复位、固定骨折,同时也可修复或重建损伤的韧带,可早期行肘关节功能练习;正确的手术入路及内固定方法是提高疗效的关键。     

儿童尺骨冠状突骨折的治疗

目的探讨儿童尺骨冠状突骨折的治疗方法。方法儿童尺骨冠状突骨折11例,年龄8·2~14岁,平均11岁。切开复位、内固定10例,非手术治疗1例。结果全部病例均获7~35个月(平均17个月)的随访,骨折均获骨性愈合,愈合时间6~10周,平均7·5周。根据Morrey肘关节功能评定标准评定疗效:优5例、良、可、差各2例,优良率63·6%。无肘关节脱位、骨化性肌炎及肘关节强直等严重并发症。结论无移位或轻度移位的稳定性骨折可采用非手术治疗,明显移位及不稳定性骨折应采用手术治疗;良好的复位是功能恢复的基础,早期功能练习是获得良好预后的关键。     

急性肘关节后脱位伴尺骨冠状突及桡骨小头骨折手术治疗

急性肘关节后脱位伴尺骨冠状突及桡骨小头骨折是一种较少见的外伤类型,它是一种复杂的肘关节脱位,约占肘关节脱位的10%~20%,因其治疗困难,预后差,被称为肘关节“可怕的三联征”(Terrible traid)[1]。2000年4月-2004年6月,对18例急性肘关节后脱位伴尺骨冠状突及桡骨小头骨折采用     

尺骨鹰嘴骨折合并肘关节前脱位的手术治疗

目的应用内固定治疗尺骨鹰嘴骨折合并肘关节前脱位。方法对15例资料完整的病例进行回顾性分析。其中男10例,女5例;年龄22－48岁,平均38岁。车祸伤9例,高处坠落伤6例。开放性损伤3例,闭合性损伤12例。尺骨鹰嘴粉碎性骨折14例,斜形骨折1例。13例合并冠状突骨折,2例合并肱骨外髁骨折。对所有病例应用内固定治疗,包括单纯张力带固定4例,张力带加螺钉固定5例,张力带加重建钢板或半管状钢板固定6例。3例行一期植骨。结果术后平均随访18个月。肘关节和前臂平均活动范围：屈肘105°,伸肘－20°;前臂旋前50°,旋后60°。按照Broberg和Morrey评估标准进行评价,优8例,良6例,可1例。其中张力带加钢板治疗组6例均为优。结论　　高能量损伤中因尺骨近端多为粉碎性骨折,且多同时合并冠状突骨折,肘关节极不稳定,单纯应用张力带固定不能获得稳定的固定,建议用重建钢板对尺骨近端骨折进行稳定固定,以获得正常的鹰嘴宽度和肱尺关节对合关系。一旦尺骨骨折向前移位得到纠正,桡骨头脱位也大多同时得到复位。存在明显骨缺损者应一期植骨。     

尺骨冠状突骨折合并肘关节脱位的治疗

目的分析尺骨冠状突骨折合并肘关节脱位的分型和治疗方法。方法15例尺骨冠状突骨折合并肘关节脱位按Reagan-Morrey分型,Ⅰ型4例采用石膏固定制动3周;Ⅱ型7例采用手术治疗,肘前方入路切开复位,前后方向拉力螺丝钉固定,早期功能锻炼;Ⅲ型4例采用手术或保守治疗,石膏固定6周。结果Ⅰ型中优2例,良1例,差1例。Ⅱ型中优4例,良2例,差1例。Ⅲ型中良2例,差2例。结论按照Reagan-Mor-rey分型指导治疗,效果较好。对于Ⅱ、Ⅲ型骨折中无粉碎骨块者,手术治疗预后好。Ⅰ型骨折石膏固定2~3周也可取得较好疗效。     

合并肘关节脱位的尺骨冠状突骨折的治疗

目的探讨合并肘关节脱位的尺骨冠状突骨折的不稳定性和手术内固定的必要性。方法分析15例合并肘关节后脱位的尺骨冠状突骨折的损伤特点．根据其分类采取相应的措施进行修复和内固定。结果15例患者均获至少2年随访,预后良好,无1例发生关节再脱位或僵硬。结论尺骨冠状突对肘关节的稳定起重要作用,根据不同类型积极处理合并肘关节后脱位的尺骨冠状突骨折。     

尺骨冠突骨折的治疗

目的探讨尺骨冠突骨折的治疗方法。方法1997年1月至2005年4月，共收治尺骨冠突骨折患者65例66侧，男54例，女11例12侧；年龄8-76岁，平均32岁；左侧29例，右侧35例，双侧1例。摔伤22例23侧，交通伤16例，机器绞轧伤14例，坠落伤10例，其他伤3例。新鲜骨折60侧，陈旧性骨折6侧。闭合性骨折59侧，开放性骨折7侧。合并同侧肘关节其他部位骨折38侧。根据Regan-Morrey分型，将骨折分为三型：Ⅰ型骨折22例，Ⅱ型骨折29例30侧，Ⅲ型骨折8例，另外6例为尺骨冠突矢状面骨折（暂称为Ⅳ型骨折）。石膏固定37侧；切开复位内固定23侧，其中螺钉固定10侧，克氏针加张力带及钢丝固定7侧，克氏针加丝线固定3侧，单纯克氏针固定2侧，钢丝环扎固定1侧；骨片摘除5侧；冠突重建1侧。结果对随访资料完整的43例（44侧）患者进行7-32个月随访，平均随访15个月，骨折均骨性愈合，愈合时间6-16周，平均12．2周。根据Morrey肘关节功能评定标准评定疗效：优25侧（56．8％），良9侧（20．5％），可6侧（13．6％），差4侧（9．1％）；优良率为77.3％。肘关节半脱位2侧，骨化性肌炎2侧，无深部感染、内固定松动或断裂、肘关节脱位及肘关节强直等严重并发症。结论Ⅰ型骨折及无移位或轻度移位的稳定性Ⅱ、Ⅳ型骨折宜采用保守治疗，对Ⅲ型骨折及明显移位的不稳定性Ⅱ、Ⅳ型骨折宜采用切开复位内固定进行治疗。     

肘关节脱位合并尺骨冠状突骨折的治疗体会

目的　探讨肘关节脱位合并尺骨冠状突骨折的适应证及近期疗效。方法　 1 995年至 2 0 0 2年共收治肘关节脱位合并尺骨冠状突骨折者 6例 ,根据骨折脱位情况 ,采用保守及手术治疗 ,其中冠状突Ⅰ型 2例 ,Ⅱ型 3例 ,Ⅲ型 1例。结果　随访 1～ 5a ,肘关节屈曲 90°～ 1 35°,前臂旋前、旋后 60°～ 70°,未见关节不稳情况。结论　肘关节脱位合并冠状突骨折是一种较少见的损伤 ,恢复肘关节的基本结构和肱尺关节的稳定性是治疗的关键     

肘关节前脱位合并尺骨鹰嘴及冠状突骨折1例报告

<正>肘关节脱位在儿童并不多见,总发病率约3%,多数为后脱位,前脱位极为罕见,且多并发骨折~([1])。普通平片可明显观察到关节脱位,CT则有助于发现骨折,尤其是碎骨块嵌顿于关节内影响肘关节复位时。近期本院成功治疗一例肘关节前脱位患儿,报道如下。     

肘关节后脱位伴桡骨头和尺骨冠突骨折 (恐怖三联征)5例初步报告

[目的]介绍"肘关节恐怖三联征"的概念(肘关节后脱位同时伴有桡骨头和尺骨冠突骨折),并报告5例患者的临床治疗体会。[方法]自2004年4月～2007年3月,作者共收治肘关节三联征损伤5例。桡骨头骨折按Mason法分类:Ⅱ型4例,Ⅲ型1例;按Schatzker法分类:Ⅰ型1例,Ⅱ型3例,Ⅲ型1例。尺骨冠突骨折按Regan-Morrey法分类:Ⅰ型1例,Ⅱ型4例;按O′Driscoll法分类:5例均为Ⅰ型。4例采取了手术内固定治疗,以3 mm钛空心拉力螺钉或1 mm K针分别固定冠突和桡骨头,并缝合修复肘内外侧副韧带。术后屈肘90°前臂旋转中立位石膏外固定3周,开始屈伸和旋转康复训练。[结果]4例手术治疗的患者经3个月～3年随访,骨折愈合,肘关节稳定,无疼痛。肘关节屈伸幅度平均120°,前臂旋转幅度平均110°。3例随访1年以上,Mayo肘关节功能评分:优2例,良1例。未手术治疗的1例功能评定为差,有肘关节不稳定和疼痛。[结论]肘关节恐怖三联征的骨折片虽然很小,但伴有肘内外侧副韧带撕裂,肘关节严重不稳定。只有在重建了骨关节和软组织结构稳定的基础上,及早(3周内)进行康复锻炼,才能获得较好的功能恢复。     

Herbert螺钉治疗Ⅲ型尺骨冠突骨折伴肘关节脱位

目的 探讨Herbert螺钉内固定对Ⅲ型尺骨冠突骨折伴肘关节脱位的治疗效果.方法 采用Herbert螺钉内固定治疗Ⅲ型尺骨冠突骨折伴肘关节脱位20例.结果 18例得到随访,随访时间7～28个月,平均16个月;骨折骨性愈合时间10～12周,平均11周;根据Morrey肘关节功能评定疗效：优12例（66.7%）,良5例（27.8%）,可1例（5.6%）,优良率为94.4%;均无深部感染、内固定松动或断裂、肘关节脱位及肘关节强直等并发症.结论 Herbert螺钉内固定治疗Ⅲ型尺骨冠突骨折伴肘关节脱位,手术创伤小、功能恢复好,是一种行之有效的手术方法.     

Dislocation of the elbow with fractures of the coronoid process and radial head

Introduction The aim of the study was to evaluate the factors relevant to prognosis after operative treatment of an elbow dislocation/fracture involving the coronoid process and the radial head. In 30–50% of cases, elbow dislocations are accompanied by concomitant bony injuries. Here, the ulnar coronoid process and the radial head are particularly crucial to the stability of the elbow joint. Materials and methods In a retrospective study, 27 out of 37 patients who were treated surgically in our clinic between 1990 and 1999 for elbow dislocation with involvement of the coronoid process and the radial head were examined after an average of 36 months. Results According to the criteria of the Morrey Score, 2 patients achieved an extremely good therapeutic result, 10 patients a good therapeutic result and 12 patients a moderate therapeutic result. A poor result was achieved in three cases. Conclusion Elbow dislocations with involvement of the ulnar coronoid process and the radial head are complex injuries and their surgical treatment and aftercare need to be handled by a skilled and experienced traumatologist. In this process, the precondition for regaining a stable joint with good function is, above all, early, exercise-stable fixation and/or reconstruction of the coronoid process and early functional mobilization of the joint.     

聚丙交酯膜防治肱骨髁上骨折术后的肘关节粘连

目的　研究在儿童移位肱骨髁上骨折切开复位术中应用聚丙交酯膜 (PLA膜 )防治肘关节粘连的效果。方法　将 4 8例肱骨髁上严重移位性骨折患儿分成两组。PLA膜组 :2 0例 ,行切开复位交叉克氏针固定后 ,于骨折部前后各放 1张大小合适的PLA膜 ;对照组 :2 8例 ,行单纯切开复位交叉克氏针固定。两组术后早期均行肘关节功能锻炼。将两组患儿术后肘关节功能恢复情况作对比分析。结果　PLA膜组随访 10～ 16个月 ,平均 12个月 ;对照组随访 12～ 16个月。术后肘关节功能优良率 :PLA膜组为 85 % ,对照组为 5 7 1% ,差异有显著性 (P <0 0 5 )。结论　PLA膜对人体无毒副作用 ,能有效防止肘关节术后粘连。     

股骨干骨折合并同侧髋臼骨折与髋关节后脱位的治疗体会

股骨干骨折是较常见的骨折，而合并同侧髋臼骨折与髋关节后脱位的发病率较低，易出现漏诊或延迟诊断。2000年1月-2005年12月，我院共收治此类患者8例，报道如下。     

肘关节后脱位并尺骨冠状突骨折9例临床疗效分析

目的 探讨肘关节后脱位并尺骨冠状突骨折的治疗方法。方法 总结2000年3月～2003年5月9例肘关节后脱位合并尺骨冠状突骨折患者的治疗经验，根据骨折类型分别采用内外侧入路对8例患者进行手术治疗，术后配合早期功能锻炼。结果 所有患者随访8～24个月，根据HSS评分标准，优5例（55.6%)，良2例（22.2%)，一般2例（22.2%)，优良率77.8%，无严重肘关节并发症发生。结论 选择恰当的手术入路和早期功能锻炼是提高该类骨折效果的关键。     

尺骨冠突骨折对肘关节稳定性的影响

目的探讨不同程度尺骨冠突骨折对肘关节稳定性的影响。方法采用11具22侧新鲜成人尸体的上肢标本,在6侧上肢上测量尺骨冠突的高度,滑车切迹开口纵径,开角的大小以及冠突1/2高度处在冠状面的宽度,矢状面的厚度等。在分别距尺骨冠突尖2mm、冠突高1/4处、冠突高1/2处、冠突高3/4处和冠突基底处截骨,测量肘关节的伸屈活动度及稳定性。另16侧上肢随机分成两组,在冠突高1/2处截骨行内固定,一组不修复尺侧副韧带前束,而另一组修复尺侧副韧带前束,分别观测伸屈时肘关节外翻角度的变化。结果尺骨冠突截骨高度不超过冠突高的1/4时,肘关节伸屈稳定性不受影响;当截骨高度达冠突高的1/2以上时,肘关节稳定性明显受影响,活动时会出现半脱位或后脱位,同时尺侧副韧带前束受损;而当尺骨冠突截骨再复位内固定后,尺侧副韧带前束断裂不修复与修复之间,肘关节屈曲0°、30°、60°、90°和120°其外翻角度有显著增加(P<0.05),肘关节不稳定,证实尺侧副韧带前束在抗外翻应力方面有重要作用。结论尺骨冠突骨折不超过冠突原高度的1/4时,对肘关节稳定性无显著影响,有手术摘除碎骨片不会影响肘关节功能;当尺骨冠突骨折超过原高度的1/2合并有尺侧副韧带前束损伤时,会明显影响肘关节稳定性,在行复位内固定的同时,应修补或重建韧带以稳定     

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.     

Surgical management of medial and lateral elbow instability secondary to acute atypical complex elbow dislocation: Case report and literature review

Introduction and importanceElbow dislocation is common in adults, and complex elbow dislocations are generally associated with bone fractures. Anteromedial coronoid fracture, in association with lateral collateral ligament (LCL) disruption, often results from varus posteromedial forces. “Terrible triad” injuries are more likely to result from valgus posterolateral forces. However, our case presentation has combined medial and lateral elbow instability in addition to “terrible triad” injury of the elbow with no radial head injury.Case presentationThe patient was a 38-year-old man with an atypical complex elbow dislocation. He was successfully treated by stabilizing the medial epicondyle and coronoid anterolateral facet fractures, in addition to LCL repair and medial collateral ligament (MCL) reconstruction. A radial head fracture was unnoted. The procedure yielded satisfactory functional outcome, with a stable and painless full elbow range of motion.Clinical discussionMulti-ligament injuries with coronoid fractures result in highly unstable elbow joints, forming a variant of the “terrible triad” injury. Surgical options vary according to the surgeon’s experience and equipment availability. In this case, direct LCL repair and MCL reconstruction were performed and were well tolerated. Elbow stability improved and the patient experienced improved functionality with minimal pain. However, it may be premature to report a definite outcome in this case because of short follow-up time postoperatively.ConclusionThe injury described in this case has a unique presentation as a multi-ligamentous injury will make the elbow very unstable. Thus, careful clinical judgment, knowledge, and experience are needed to identify the underlying injury and for optimal management.