克氏针钛缆张力带治疗尺骨鹰嘴骨折的疗效

目的 探讨克氏针钛缆张力带治疗MayoⅡ型尺骨鹰嘴骨折的临床疗效。方法 采用克氏针钛缆张力带治疗23例MayoⅡ型尺骨鹰嘴骨折患者。记录骨折愈合情况、关节活动度和术后并发症情况，采用肘关节功能Mayo评分评价疗效。结果 患者均获得随访，时间3～16个月。切口均愈合，无感染、骨化性肌炎、创伤性关节炎、骨折端分离、克氏针及钛缆断裂等并发症发生。末次随访时骨折均愈合。术后3个月，肘关节屈曲125°～150°(133.5°±6.8°),前臂旋前65°～85°(76.0°±1.6°)、旋后70°～80°(79.0°±1.9°);肘关节功能Mayo评分为70～100分，其中优16例，良6例，中1例，优良率22/23。结论 采用克氏针钛缆张力带治疗MayoⅡ型尺骨鹰嘴骨折固定效果较佳，功能恢复良好，可取得较满意效果。     

闭合复位自制外固定架治疗尺骨鹰嘴骨折

目的：探讨利用弹力克氏针闭合复位结合功能训练法治疗尺骨鹰嘴骨折新方法的可行性和优缺点。方法：1997年6月--2002年6月应用直径2mm、长30cm的克氏针3根以及自制前臂外固定圈组成的外固定架，经闭合穿针徽创手术弹性外固定治疗尺骨鹰嘴骨折18例，透视下复位穿针外固定，术后第一天开始功能训练。结果：18例均在6周--12周内临床愈合，肘关节功能均恢复满意。无感染等并发症发生。结论：弹力克氏针微创手术弹性固定结合功能训练法治疗尺骨鹰嘴骨折操作简单，创伤小，住院时间短，无须二次手术，功能恢复完全，是治疗尺骨鹰嘴骨折可行而有效的新方法。     

可抽出张力带钢丝固定治疗尺骨鹰嘴骨折

尺骨鹰嘴骨折在四肢损伤中是一种常见的骨折.以往传统的治疗是牵引,石膏固定或手术固定.但由于术后肘关节不能早期功能锻炼,而遗留下肘关节的功能障碍,我们自1986年8月以来采用自己设计的可抽出平行双克氏针张力带钢丝内固定术治疗尺骨鹰     

双皮质法张力带固定治疗尺骨鹰嘴骨折

尺骨鹰嘴骨折是较常见的关节内骨折,治疗目标要求尽量解剖复位和早期功能锻炼,因此对大多数尺骨鹰嘴骨折均主张手术治疗.常见的内固定方法是用克氏针或螺钉穿过尺骨近端一侧皮质插入髓腔内加钢丝作张力带固定[1-3].     

闭合复位弹性克氏针联合外固定架固定治疗儿童尺骨鹰嘴骨折疗效分析

目的 观察采用2枚克氏针辅助闭合复位弹性克氏针联合外固定架固定治疗儿童尺骨鹰嘴骨折的临床疗效。方法 回顾性分析自2010-03—2022-01诊治的49例儿童尺骨鹰嘴骨折,其中16例采用闭合复位弹性克氏针联合外固定架固定治疗（闭合复位组）,33例采用切开复位克氏针钢丝张力带内固定治疗（切开复位组）。比较两组手术时间、术中出血量、住院时间、骨折愈合时间,骨折复位质量、骨折端最大移位宽度,以及末次随访时肘关节活动度与肘关节功能。结果 49例手术均顺利完成并获得随访,随访时间12～27个月,平均15.2个月。随访期间患者均未出现切口感染、钉道感染、克氏针松动、骨折再移位、尺骨近端骨骺发育异常等并发症。切开复位组1例克氏针尾部皮肤激惹,取出克氏针后症状消失。与切开复位组比较,闭合复位组手术时间与住院时间更短,术中出血量更少,差异有统计学意义（P<0.05）。闭合复位组骨折愈合时间较切开复位组短,差异有统计学意义（P<0.05）;两组末次随访时肘关节功能BrobergMorrey评分、肘关节活动度（屈曲、伸直、前臂旋前、前臂旋后）差异无统计学意义（P>0.05）。结论 闭合复位...     

肘关节“恐怖三联征”合并尺骨鹰嘴骨折的手术治疗

目的 探讨肘关节“恐怖三联征”合并尺骨鹰嘴骨折的手术方法和疗效.方法 对此类骨折12例采用螺纹克氏针双皮质“8”字张力带固定尺骨鹰嘴骨折;螺纹克氏针固定尺骨冠突骨折;用可溶性钉棒固定桡骨头骨折.结果 12例经过3～24个月的随访,骨折全部愈合.肘关节功能评分结果:优7例,良3例,中2例.结论 肘关节“恐怖三联征”合并尺骨鹰嘴骨折,必须重建肘骨关节和软组织的解剖结构,早期进行功能锻炼,才能获得较好的功能康复.     

交叉克氏针双张力带螺钉治疗肱骨髁间骨折

目的评价交叉克氏针双张力带螺钉结合治疗肱骨髁间骨折疗效。方法采用经尺骨鹰嘴截骨入路,交叉克氏针双张力带螺钉结合治疗肱骨髁间骨折21例。结果全部获得随访,时间6个月～4年。术后无感染病例,骨折愈合时间3～7个月,无骨折不愈合发生。1例术后一过性尺神经麻痹,3例出现轻微退针现象。按Aitken和Rorabeek标准评价疗效：优7例,良10例,可3例,差1例。结论采用经尺骨鹰嘴截骨入路交叉克氏针双张力带螺钉结合治疗肱骨髁间骨折,具有显露良好、操作简单、固定牢靠等特点,通过早期功能锻炼,效果满意。     

普通克氏针与髌骨针张力带治疗Schatzker A-C型尺骨鹰嘴骨折的疗效比较

尺骨鹰嘴骨折约占上肢骨折的10%左右［1］,此骨折除少数尖端撕脱骨折外,多波及关节面,因此,为获得解剖复位,减少创伤性关节炎发生率,选择牢固、确切的固定方法恢复其关节面的正常解剖对位,是早期功能锻炼获得良好关节功能的重要条件［2］。本研究对本院采用普通克氏针张力带或髌骨针张力带治疗并获得完整随访的尺骨鹰嘴骨折患者进行回顾性分析。     

带孔克氏针张力带技术在尺骨鹰嘴骨折中的应用

尺骨鹰嘴骨折在临床上多见。治疗方式多样，以克氏针张力带技术常用。该技术存在一些并发症。如克氏针滑动旋转、纲丝脱套等。自2000年2月至2006年6月．笔者采用带孔克氏针张力带技术治疗尺骨鹰嘴骨折40例，取得良好效果。现总结报告如下。     

克氏针弹性外固定治疗尺骨鹰嘴骨折（附15例报告）

目的：探讨利用弹性固定原理治疗尺骨鹰嘴骨折的新方法。方法：1996年6月以来临床应用直径2mm、长30cm的克氏针3根及自制前臂外固定圈组成外固定架,弹性外固定治疗尺骨鹰嘴骨折15例,年龄16－45岁,均为横斜性骨折。其中开放性骨折3例,闭合性骨折12例。臂丛麻醉C臂光机透视下复位穿针外固定。结果：15例患者6－12周临床愈合,平均8周,肘关节功能均恢复满意。无感染等并发症发生。结论：克氏针弹性外固定法操作简单,创伤小,住院时间短（其中门诊治疗3例）,无需3次手术,功能恢复完全,是治疗尺骨鹰嘴骨折非常有效的新方法,是弹性（张力带）固定原理的合理运用。     

K-wire position in tension band wiring of the olecranon - a comparison of two techniques

Tension band wiring is a recognised standard treatment for olecranon fractures. We studied the effect of K-wire position on backing out of the wire in a group of 80 patients with closed transverse olecranon fractures with a minimum follow-up time of 9 months. The rate of wires backing out as seen on X-ray was three times greater in patients who had K-wires passed down the long axis of the ulna rather than across the anterior cortex as recommended by the AO group. There was a corresponding higher rate of local complications in these patients. 42% of this group had to have the metal removed compared with 11.4% of the transcortical group. We compared the biomechanical properties of both K-wires positions in a human cadaveric model. The maximum pull-out strength for each configuration was recorded in 20 elbow joints. The average maximum pullout strength for the intramedullary wires was 56.3 N (range 27. 7-95.6 N) and 122.7 N for the transcortical wires (range 56.7-201.2). The results of both the clinical study and biomechanical data support the routine use of transcortical placement of K-wires in tension-band wiring of transverse olecranon fractures.     

Management of heterotopic ossification and restricted forearm rotation after tension band wiring for olecranon fracture

A 32-year-old lady presented to our clinic with persistent painful restriction of her dominant forearm movements for three months after tension band wiring of olecranon. She had full elbow flexion and extension; however, her forearm rotations were restricted and painful. Investigations revealed prominent tips of the wire, eroding the radial tuberosity with heterotopic ossification between the radius and ulna. As there was no synostosis, the patient had implant exit. During surgery, before implant removal, examination under anaesthesia revealed a mechanical block of the rotation beyond 30° on pronation and supination from neutral. However, after the removal of implant, the mechanical block eased off and with gentle manipulation, full pronation and supination were achieved. At the final follow-up at 6 months, the patient had full pain-free forearm rotation with regression of heterotopic ossification. Our case report highlights the importance of intra-operative assessment of wire tips at full supination and pronation, and in patients with restricted forearm rotation, CT scan may be needed to assess the position of the hardware is essential as it can progress to synostosis. In cases with prominent hardware, removal of the implant may suffice if performed before the development of synostosis     

Impaired forearm rotation after tension-band-wiring fixation of olecranon fractures: evaluation of the transcortical K-wire technique

The tension-band-wiring technique is a well-accepted method of internal fixation of olecranon fractures. In addition, it is suggested that transcortical placement of the k-wires results in lower rates wire migration. We encountered two clinical cases in which transcortical placement of the k-wires led to impairment of forearm rotation. An anatomic study was conducted to study the effect of transcortical wire placement to avoid similar future complications. Using specimens from 10 embalmed cadavers, we found that transcortical wires inserted in <30 degrees of ulnar angulation in the coronal plane to the medial ridge of the olecranon, impinged on the radial neck, supinator muscle, or biceps tendon. This was avoided in all 10 specimens when the wires were inserted, with the forearm in supination, at 30 degrees of ulnar angulation. We recommend this technique to be adopted to avoid forearm rotation impairment.     

Safe zone for anterior cortical perforation of the ulna during tension-band wire fixation: a magnetic resonance imaging analysis

Placing K-wires obliquely through the anterior ulnar cortex is a common modification of traditional olecranon tension-band wiring. Wire tip protrusion, however, risks injury to adjacent neurovascular structures and may impede forearm rotation. This study examines the proximity of neurovascular structures to the anterior proximal ulnar cortex. The anatomy of 47 adult elbows was examined through magnetic resonance imaging. A radiologist measured the spatial relationship of 6 neurovascular structures to a mid-sagittal reference point 1.5 cm distal to the coronoid on the anterior surface of the ulna. Distance and angular measurements were made in the transverse plane of the reference point. Within a reasonable arc of K-wire placement, the ulnar artery and median nerve were at greatest risk yet were still beyond 10 mm from the anterior ulnar cortex. To avoid iatrogenic neurovascular injury during tension-band wiring of the olecranon, protrusion of wire tips beyond the anterior ulnar cortex should be no more than 1 cm at a distance of 1.5 cm distal to the coronoid.     

A mechanical study of the moment-forces of the supinators and pronators of the forearm

We determined the torque generated by the muscles rotating the forearm at varying degrees of pronation and supination. We used 8 human cadaveric upper extremity specimens with the humerus and ulna rigidly fixed with the elbow in 90 degrees of flexion, while free rotation of the radius around the ulna was allowed. The tendons of the flexor carpi ulnaris (FCU), extensor carpi ulnaris (ECU), supinator, biceps, pronator teres (PT), and the pronator quadratus' (PQ) superficial and deep heads were isolated. After locking the forearm at intervals of 10 degrees from 90 degrees of pronation to 90 degrees of supination, we loaded each muscle/tendon with a ramp profile. We found that the biceps and supinator are both active supinators, the biceps generating four times more torque with the forearm in a pronated position. As for pronation, the PT and both heads of the PQ are active throughout the whole rotation, being most efficient around the neutral position of the forearm. The ECU and FCU contribute significantly less to pronation and supination torque. However, they do generate potential pronating torque while the forearm is positioned maximally in supination and, to a lesser extent, potential supination torque while the forearm is positioned maximally in pronation.     

Angular deformities and forearm function.

Angular deformities were created in cadaver forearms at proximal, middle, and distal third levels of the radius and ulna separately, and at middle and distal third levels of both bones, to determine the corresponding limitations of pronation and supination. The ranges of pronation and supination were recorded using a rotational motion measurement apparatus instrumented with a 360 degrees goniometer. These experimental results were compared to data obtained from clinical and radiographic examination of 105 patients with similar residual deformities following treatment of fractures by nonsurgical means, to evaluate the accuracy of the experimental model and to determine if loss of rotational motion could be predicted based on radiographic findings. With cadaver forearms, on the average, angulation of 10 degrees of the radius or ulna in coronal or sagittal planes limited pronation and supination by less than 24 degrees, whereas angulation of 10 degrees of both the radius and the ulna limited pronation and supination by less than 18%. Comparison of experimental results with clinical findings showed that, despite the errors involved in measuring forearm deformities in patients using biplanar radiographs, the experimental results predicted the clinical loss of pronation and supination to within 17% for the fractures of the radius, and within 8% accuracy for the fractures of the ulna.     

A mechanical study of the moment-forces of the supinators and pronators of the forearm

We determined the torque generated by the muscles rotating the forearm at varying degrees of pronation and supination. We used 8 human cadaveric upper extremity specimens with the humerus and ulna rigidly fixed with the elbow in 90° of flexion, while free rotation of the radius around the ulna was allowed. The tendons of the flexor carpi ulnaris (FCU), extensor carpi ulnaris (ECU), supinator, biceps, pronator teres (PT), and the pronator quadratus' (PQ) superficial and deep heads were isolated. After locking the forearm at intervals of 10° from 90° of pronation to 90° of supination, we loaded each muscle/tendon with a ramp profile. We found that the biceps and supinator are both active supinators, the biceps generating four times more torque with the forearm in a pronated position. As for pronation, the PT and both heads of the PQ are active throughout the whole rotation, being most efficient around the neutral position of the forearm. The ECU and FCU contribute significantly less to pronation and supination torque. However,they do generate potential pronating torque while the forearm is positioned maximally in supination and, to a lesser extent, potential supination torque while the forearm is positioned maximally in pronation.     

A mechanical study of the moment-forces of the supinators and pronators of the forearm

We determined the torque generated by the muscles rotating the forearm at varying degrees of pronation and supination. We used 8 human cadaveric upper extremity specimens with the humerus and ulna rigidly fixed with the elbow in 90° of flexion, while free rotation of the radius around the ulna was allowed. The tendons of the flexor carpi ulnaris (FCU), extensor carpi ulnaris (ECU), supinator, biceps, pronator teres (PT), and the pronator quadratus' (PQ) superficial and deep heads were isolated. After locking the forearm at intervals of 10° from 90° of pronation to 90° of supination, we loaded each muscle/tendon with a ramp profile.

We found that the biceps and supinator are both active supinators, the biceps generating four times more torque with the forearm in a pronated position. As for pronation, the PT and both heads of the PQ are active throughout the whole rotation, being most efficient around the neutral position of the forearm. The ECU and FCU contribute significantly less to pronation and supination torque. However,they do generate potential pronating torque while the forearm is positioned maximally in supination and, to a lesser extent, potential supination torque while the forearm is positioned maximally in pronation.     

An analysis of the constraint properties of the distal radioulnar ligament attachments to the ulna.

Nine cadaver upper extremities were tested to evaluate the constraint properties of the dorsal and palmar radioulnar ligaments at their foveal and styloid attachments to the ulna. The specimens were tested by anterior and posterior displacement of the radius relative to the ulna with the forearm in pronation, supination, and neutral rotation. There were no statistically significant differences in the relative percent of constraint contribution of the styloid and foveal ligament insertions. In neutral forearm rotation total displacement after sectioning both ligament insertions tended to be larger in palmar than in dorsal displacement. A similar trend was observed with 60 degrees forearm supination. In the pronated position, however, the trend was reversed with larger total displacement in dorsal displacement.     

The effect of rotational malunion of the radius and the ulna on supination and pronation

We have assessed the influence of isolated and combined rotational malunion of the radius and ulna on the rotation of the forearm. Osteotomies were made in both the radius and the ulna at the mid-diaphyseal level of five cadaver forearms and stabilised with intramedullary metal implants. Malunion about the axis of the respective forearm bone was produced at intervals of 10 degrees. The ranges of pronation and supination were recorded by a potentiometer under computer control. We examined rotational malunions of 10 degrees to 80 degrees of either the radius or ulna alone and combined rotational malunions of 20 degrees to 60 degrees of both the radius and ulna. Malunion of the ulna in supination had little effect on rotation of the forearm. Malunion of either the radius or of the ulna in pronation gave a moderate reduction of rotation of the forearm. By contrast, malunion of the radius in supination markedly reduced rotation of the forearm, especially with malunion greater than 60 degrees. Combined rotational malunion produced contrasting results. A combination of rotational malunion of the radius and ulna in the same direction had an effect similar to that of an isolated malunion of the radius. A combination in the opposite direction gave the largest limitation of the range of movement. Clinically, rotational malunion may be isolated or part of a complex angular/rotational deformity and rotational malunion may lead to marked impairment of rotation of the forearm. A reproducible method for assessing rotational malunion is therefore needed.