尺骨鹰嘴骨折的手术治疗

2000年7月～2007年7月,我院采用张力带钢丝和鹰嘴钢板手术内固定治疗尺骨鹰嘴骨折41例,临床效果满意。1材料与方法1.1病例资料本组41例,男26例,女15例,年龄13～62岁。致伤原因：摔伤18例,车祸伤10例,高处坠落伤9例,刀砍伤4例。按Mayo分型：Ⅱ型22例,Ⅲ型19例。合并尺骨冠突骨折11例,肘关节前脱位6例。1.2手术方法臂丛神经阻滞麻醉,显露骨折端,直视下整复骨折端,用C形复位钳固定。     

Surgical treatment of olecranon fractures

Fractures of the olecranon are common injuries with no single accepted treatment. Numerous clinical factors and biomechanical studies guide the surgeon in determining a treatment plan. The goals of surgical management include anatomical reduction and stable fixation, which allow early range of motion of the elbow joint. Numerous fixation methods have been described and include screw fixation, cerclage wiring, modified tension-band wiring, and plate fixation. The surgical technique depends on a combination of patient factors, the fracture pattern, and the mechanical stability of the fixation construct. Postoperative rehabilitation includes early active range-of-motion exercises and follows clinical and radiographic healing. Complications are related to the fracture, choice of implant, and surgical technique.     

Surgical treatment of fractures of the olecranon]

56 patients with olecranon displaced fractures have been studied. The diastasis exceeding 1 cm and the failure of the closed reposition served as indications for surgical interventions. The olecranon fixation was performed by means of silk and wire sutures (11 cases), with a screw (8), with a rod (4), with a compression fixative, devised by the author (33). The check of the late results in 54 patients has shown the union of the fracture and good results in all the cases, but as to the terms of the functional and working capacity restoration--it was 2 to 3 times shorter with the osteosynthesis with the compression fixative than with the suture or rod osteosynthesis.     

Surgical treatment of olecranon fractures in children

Background  

Fractures of the olecranon are relatively uncommon in children and most are non-displaced or minimally displaced. Wire and suture methods have been used to stabilize displaced pediatric olecranon fractures. This study compares differences in the clinical outcome of 15 children either treated with open reduction and screws, tension band suture (TBS), tension band wires (TBW), or plating.     

Comminuted olecranon fractures: a comparison of plating methods

The relative strength of posterior plating and dual medial-lateral plating for comminuted olecranon fractures has not been evaluated. Fifteen male cadaveric elbows with simulated highly comminuted olecranon fractures were tested to failure via cantilever bending. The strength of dual medial-lateral plates and a single posterior plate with and without an intramedullary screw was evaluated. The mean bending moment at failure for the dual-plated specimens was 30.0 +/- 7.5 Nm. The mean bending moment at failure for specimens with a posterior plate without an intramedullary screw was 34.5 +/- 9.1 Nm. The mean bending moment at failure for specimens with a posterior plate and an intramedullary screw was 44.5 +/- 6.9 Nm; this was significantly greater than for dual-plated specimens (P < .05) but not for specimens with a posterior plate without an intramedullary screw. The posterior plate with an intramedullary screw was the most stable construct tested and may, therefore, be the preferred method of fixation for comminuted olecranon fractures. This construct was significantly (48%) stronger than dual medial and lateral plating.     

尺骨鹰嘴骨折-脱位手术治疗的疗效分析

目的探讨手术治疗尺骨鹰嘴骨折-脱位的效果,对手术方式和术中注意事项进行分析。方法采用手术治疗20例鹰嘴骨折-脱位,14例采用尺骨解剖钢板固定,6例使用张力带,5例在内固定后发现仍不稳定再加用外固定架固定。结果20例获随访15～30个月（平均24个月）。末次随访时肘关节功能Broberg＆Morrey评分：优6例,良5例,一般6例,差3例。15例出现关节异位骨化表现（75％）,严重2例,中度5例,轻度8例。结论依据鹰嘴骨折一脱位类型与损伤机制选择适当的手术方式治疗,有利于鹰嘴形态和力线以及肘部稳定性的恢复,减少术后并发症发生。术后异位骨化发生率很高。应当早期干预。     

Functional results after operative treatment of olecranon fractures

In a retrospective, nonrandomized study, we reviewed our experience with the operative treatment of olecranon fractures to find out which factors correlate with subjective complaints and functional outcome. A total of 95 consecutive olecranon fractures were operatively treated in our level I trauma institution between March 1, 1992 and March 1, 2000. Medical charts and radiographs of all patients were evaluated. Three patients died, 23 were lost to follow-up. Fifty-eight of 69 available patients (84.0%) were reviewed clinically and/or radiologically after a mean time interval of 36 months. Fracture type, fracture classification, associated lesions, technical correctness of osteosynthesis, age and comorbidity were analysed. Radiological end result (intraarticular step-offs, gaps, arthrosis), subjective complaints, mobility of the elbow joint and muscle strength were evaluated. Patients with an unstable elbow (Mayo classification type III and Schatzker-Schmeling classification type D) had a higher loss of elbow function than others. There was a correlation between fracture morphology (fractures type C and D in the Schatzker-Schmeling classification) and arthrosis. There also was a correlation between suboptimal osteosynthesis and arthrosis. There was no correlation between suboptimal osteosynthesis, implant loosening and secondary procedures. Patients more often expressed subjective complaints and loss of function in activities of daily life before than after hardware removal. Primary elbow instability and fracture morphology are prognostic factors for elbow function and development of arthrosis after operative treatment of olecranon fractures. We therefore recommend the classification systems of the Mayo-clinic or of Schatzker-Schmeling. As many patients have complaints related to the implants, we recommend hardware removal after fracture healing.     

Comparative effectiveness of various methods of surgical,combined and comprehensive treatment of patients with colonic cancer

The results of radical treatment of cancer recti using surgical and combined methods, which had envisaged application of preoperative irradiation, systemic chemotherapy with the add of fluorouracil and calcium folinate, intraarterial polychemotherapy with the help of fluorouracil, adriablastinum on background of verapamil, endolymphatic polychemotherapy with local hyperthermy of ultra-high frequency, intraoperative intraperitoneal polychemotherapy and autoimmunotherapy with application of antitumoral vaccine. After application of autoimmunotherapy, endolymphatic polychemotherapy, preoperative intensive gamma-therapy in combined treatment of patients with cancer recti II-III stages the indexes of five-year survival had improved.     

解剖型钢板治疗粉碎性尺骨鹰嘴骨折

目的 探讨解剖型钢板治疗粉碎性尺骨鹰嘴骨折的疗效.方法 2002年2月至2007年7月,共52例移位粉碎性尺骨鹰嘴骨折的患者,男37例,女15例,平均年龄37.6岁.按照Mayo分型:其中ⅡB型31例,ⅢB型21例.所有骨折均行切开复位解剖型钢板内固定.结果 术后49例获得随访,随访时间为12～20个月,平均14.2个月.所有骨折均于3个月内愈合,无伤口感染;3例由于钢板皮下激惹,取出内固定后症状缓解.术后采用Broderg和Money评分标准进行评估:30例ⅡB型骨折中优22例,良6例,可2例,差0例,优良率为93.3%;19例ⅢB型骨折中优6例,良8例,可4例,差1例,优良率为73.7%.两组疗效差别有统计学意义(P<0.05).结论 解剖型钢板是治疗粉碎性尺骨鹰嘴骨折的安全有效的方法,Mayo分型可作为判断骨折预后的依据.     

The complications of surgical treatment of displaced fractures of the olecranon

Forty-eight patients who had undergone internal fixation of a displaced fracture of the olecranon by either a tension band technique (34 patients) or screwing (14 patients) were reviewed. The functional results after at least 2 years were equally good with both methods, but there was a considerably higher rate of separation at the fracture after screwing than after inserting a tension band. The technical quality of the fixation was open to criticism in half the cases in each group, and the implications of this are discussed.