尺骨鹰嘴骨折-脱位伴桡骨头及冠状突骨折的手术治疗

目的总结尺骨鹰嘴翻转入路内固定或桡骨头置换治疗尺骨鹰嘴骨折-脱位伴桡骨头及冠状突骨折的疗效及此类骨折命名。方法 2013年8月—2017年3月,收治16例伴桡骨头及冠状突骨折且无上尺桡关节脱位的尺骨鹰嘴骨折-脱位患者,采用后正中尺骨鹰嘴翻转入路内固定或桡骨头置换治疗。男10例,女6例;年龄25～66岁,平均37.8岁。交通事故伤9例,高处坠落伤7例。受伤至手术时间5～11 d。9例前脱位患者中冠状突骨折ReganⅠ型2例、Ⅱ型3例、Ⅲ型4例,桡骨头骨折MasonⅡ型4例、Ⅲ型5例;7例后脱位患者中冠状突骨折ReganⅠ型1例、Ⅱ型3例、Ⅲ型3例,桡骨头骨折MasonⅡ型3例、Ⅲ型4例。结果术后切口均Ⅰ期愈合。16例术后均获随访,随访时间9～18个月,平均11.9个月。X线片示骨折均于术后12～18周达临床愈合,随访期间肱尺关节、肱桡关节对合关系正常,骨折复位无丢失,内固定物及桡骨头假体无松动。术后发生肘关节轻度异位骨化2例,轻度创伤后关节炎2例,克氏针退出2例。末次随访时肘关节稳定,活动度恢复较好。Mayo肘关节功能评分(MEPS)为70～100分,平均86.5分。VAS评分0～3分,平均0.5分。结论伴桡骨头及冠状突骨折且无上尺桡关节脱位的尺骨鹰嘴骨折-脱位可以"经尺骨鹰嘴肘关节周围骨折脱位"命名,采用尺骨鹰嘴翻转入路内固定或桡骨头置换可取得满意疗效。     

合并尺骨鹰嘴骨折的肘关节前脱位

目的：报告7例合并尺骨鹰嘴骨折的肘关节前脱位。其中尺骨鹰嘴单纯斜形骨折1例，尺骨近端粉碎性骨折6例，肱骨远端穿过尺骨鹰嘴，肘关节向前脱位。方法：均采用切开复位内固定术。结果：平均随访18个月，肘关节功能恢复极好2例，好4例，差1例。结论：合并尺骨鹰嘴骨折的肘关节前脱位大多发生于尺骨近端复杂的粉碎性骨折，肱骨远端穿过尺骨鹰嘴，同时伴有肱桡关节脱位，但上桡尺关节未有分离。尺可能地使滑车切迹达到解剖复位并作稳固的内固定，大都能达到满意的治疗效果。     

肘关节"恐怖三联征"合并尺骨鹰嘴骨折的手术治疗

目的 介绍肘关节"恐怖三联征"合并尺骨鹰嘴骨折的手术方法和疗效.方法 肘关节"恐怖三联征"合并尺骨鹰嘴骨折患者12例,男8例,女4例;年龄21~75岁,平均40.4岁.桡骨头骨折按Mason分型:Ⅱ型7例,Ⅲ型5例;因合并肘关节脱位,按Johnston-Mason分型均为Ⅳ型.冠突骨折按Regan-Morrey分型:Ⅰ型2例,Ⅱ型4例,Ⅲ型6例.尺骨鹰嘴骨折按Mayo分型Ⅱa型2例,Ⅱb型2例,Ⅲa型2例,Ⅲb型6例.9例肘关节后脱位,3例为前脱位.12例均行手术治疗,冠突、鹰嘴骨折行内固定;桡骨头骨折行内固定、桡骨头切除、金属桡骨头置换,修复内、外侧副韧带.术后石膏托维持肘关节屈曲90°,前臂中立位固定3周.结果 8例(66.7%)患者获得随访,随访时间3~36个月.平均16.4个月.骨折全部愈合,愈合时间10~16周,平均14.2周.Broberg-Morrey评分为55~95分,平均88分,优4例,良2例,可1例,差1例,优良率为75.0%.肘关节屈伸范围为70°~150°,平均127.5°;前臂旋转范围为65°~155°,平均122.5°.结论 肘关节"恐怖三联征"合并尺骨鹰嘴骨折为高能量损伤,关节严重不稳定,必须重建骨关节及软组织的解剖结构,恢复肘关节稳定性.     

后内侧双钢板治疗复杂尺骨鹰嘴骨折的疗效观察

目的探讨后内侧双钢板治疗复杂尺骨鹰嘴骨折的疗效。方法回顾分析2011年9月-2015年7月采用尺骨鹰嘴解剖钢板联合内侧微型钢板治疗的13例复杂尺骨鹰嘴骨折患者临床资料。男8例,女5例;年龄22~68岁,平均41.6岁。致伤原因:交通事故伤4例,高处坠落伤6例,金属物击伤3例。均为闭合性损伤。骨折根据Mayo分型标准:ⅡB型5例,ⅢB型8例。合并冠状突骨折7例,均为Regan-MorreyⅢ型;肘关节前脱位5例,后脱位2例。受伤至入院时间1.5~10.0 h,平均5.7 h。术后X线片复查骨折愈合情况;末次随访时,根据Broberg-Morrey肘关节功能评价标准评定肘关节功能。结果术后患者切口均Ⅰ期愈合,无尺神经损伤等相关并发症发生。患者均获随访,随访时间9~38个月,平均22.1个月。X线片复查示骨折均愈合,愈合时间3.0~5.5个月,平均3.7个月;发生1例桡骨头半脱位,1例轻度异位骨化,但无肘关节屈伸活动障碍、关节不稳定及疼痛不适症状,未给予特殊处理。末次随访时,肘关节伸屈活动度达95~130°,平均116.4°;旋转活动度为150~175°,平均170.8°;肘关节功能按Broberg-Morrey肘关节功能评价标准,获优4例,良7例,可2例,优良率84.6%。无内固定失败、肘关节僵硬及创伤性骨关节炎等并发症发生。结论尺骨鹰嘴解剖钢板联合内侧微型钢板可牢固固定骨折、重建滑车切迹,允许术后早期锻炼,治疗复杂尺骨鹰嘴骨折可获得满意疗效。     

应用尺骨近端解剖钢板治疗鹰嘴骨折

[目的]探讨切开复位钢板内固定治疗尺骨鹰嘴骨折疗效.[方法]回顾分析本院自2006年10月～2009年10月治疗53例尺骨鹰嘴骨折资料,其中男28例,女25例；年龄20～55岁,平均38.6岁；左侧19例,右侧34例；简单骨折39例,粉碎骨折14例；开放性骨折2例,闭合性骨折51例,其中合并尺骨冠状突骨折2例,合并桡骨小头骨折、肘关节前脱位2例.手术时机:伤后2h～7d(平均3.5d).[结果]53例患者均获得随访,随访时间12 ～31个月,平均23.5个月.骨折愈合良好,平均愈合时间4.8个月(3～9个月).按Broberg疗效评定标准评定,疗效优37例,良11例,优良率90.6％.[结论]钢板固定能够恢复滑车切迹解剖结构,利于早期功能练习,骨折愈合率高,并发症少,临床疗效良好,是鹰嘴骨折较好治疗方案之一.     

尺骨冠状突骨折复位固定对肘关节骨折脱位术后肘关节稳定的意义

目的探讨尺骨冠状突骨折复位固定对复杂肘关节骨折脱位术后维持肘关节稳定的意义。方法回顾性分析自2008-03—2013-07采用切开复位内固定治疗的17例复杂肘关节骨折脱位,术中对尺骨冠状突骨折进行复位固定。末次随访时按Mayo评分标准评定肘关节功能。结果本组17例均获得随访18~60个月,平均38个月。切口均一期愈合。所有患者术后12~24周骨折端获得临床愈合,前臂旋转活动恢复良好。除1例Regan-Morrey Ⅲ型尺骨冠状突骨折患者在术后8~12周时肘关节屈伸活动受限,其他患者肘关节屈伸活动均接近正常。术后均未出现感染、内固定松动或断裂、骨不连、肘关节强直和再脱位等并发症。末次随访时按Mayo评分标准评定肘关节功能:优6例,良8例,可2例,差1例。结论对于合并尺骨冠状突骨折的复杂肘关节骨折脱位,尺骨冠状突骨折复位固定是手术的关键,对术后维持肘关节稳定有着重要意义,进而保证肘关节功能恢复良好。     

经鹰嘴肘关节骨折脱位诊断与治疗

经鹰嘴肘关节骨折脱位是一种伴有尺骨近端复杂性损伤的肘关节前脱位,临床较少见且具有明显特征,常由高能量暴力直接作用于半屈曲状态的前臂背侧面所致.肘关节X线片表现为鹰嘴骨折或尺骨近侧干骺端骨折,侧位片显示相对于肱骨滑车的尺桡骨近端向前移位.虽发生脱位,但韧带关节囊很少受累,鹰嘴和滑车切迹常发生复杂的粉碎性骨折,多伴有冠突基底部骨折.由于对其致伤机制和病理过程认识较少,常认为是鹰嘴骨折中的一种类型,易误诊为单纯鹰嘴骨折或Monteggia损伤.治疗需要手术干预,通过合理的内固定装置恢复滑车切迹的轮廓和尺度,同时积极处理伴发的冠突骨折、桡骨小头骨折,常可获得令人满意的治疗效果.     

MayoⅡB型尺骨鹰嘴骨折的关节面重建

目的总结MayoⅡB型尺骨鹰嘴骨折术中重建滑车切迹关节面的方法及疗效。方法 2009年1月-2010年12月,收治10例直接暴力所致MayoⅡB型尺骨鹰嘴骨折患者。男6例,女4例;年龄21～65岁,平均31.5岁。受伤至手术时间为2～11 d,平均5 d。术中根据滑车切迹关节面骨缺损程度,采用直接复位、截骨短缩复位或植骨重建关节面。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间8～13个月,平均10个月。X线片示骨折愈合时间为6～8周,平均6.5周;无关节面塌陷等并发症发生。术后8个月根据Mayo关节功能评分标准评定疗效,获优6例,良3例,可1例,优良率为90%。结论对于MayoⅡB型尺骨鹰嘴骨折,术中重建滑车切迹关节面是恢复肘关节良好功能的基础。     

可吸收缝线辅助固定治疗肘关节软骨骨折

目的报告可吸收缝线辅助缝合固定治疗肘关节软骨骨折的临床疗效。方法回顾性分析自2016年6月至2021年3月收治的21例肘关节软骨骨折患者的临床资料, 其中肘关节脱位伴肱骨内髁骨折桡骨小头骨折1例, 桡骨小头骨折伴软骨部分游离6例, 桡骨小头骨折伴肱骨小头骨折6例, 肱骨远端关节内骨折3例, 肘关节脱位伴桡骨小头尺骨冠突骨折4例, 尺骨鹰嘴桡骨小头尺骨冠突骨折1例。所有患者均在术中使用可吸收缝线进行缝合辅助固定关节软骨骨折块。术后根据Broberg-Morrey肘关节功能评分标准评价肘关节功能, 记录肘关节的屈伸活动度及前臂旋转活动度。结果术后所有患者均获得随访, 时间为13～64个月, 平均23个月。1例因关节周围异位骨化形成二期行关节松解手术;1例内侧副韧带钙化, 肘关节僵硬。末次随访时患侧肘关节平均屈曲119.8°(90°～140°), 伸直-3.8°(-45°～0°);前臂旋前78.3°(46°～84°), 旋后79.6°(62°～87°)。肘关节Broberg-Morrey评分为59～95分, 平均91.2分;优12例, 良8例, 差1例。结论通过缝合固定技术修复肘关节软骨骨折...     

前后路联合手术治疗尺骨鹰嘴并冠状突骨折

目的探讨应用前后路联合手术方式治疗尺骨鹰嘴并冠状突骨折的疗效。方法回顾性分析2012年5月至2014年8月采用前后路联合手术方法治疗32例尺骨鹰嘴并冠状突骨折,男21例,女11例;年龄26~57岁,平均37.7岁。所有患者均采用前后联合入路,冠状突骨折使用微型接骨板给予固定,尺骨鹰嘴骨折使用解剖接骨板给予固定,术中均达到牢固固定。记录骨折复位、固定后是否有骨折复位丢失、骨折愈合时间和并发症情况。末次随访时采用Mayo肘关节功能评分(mayo elbow performance score,MEPS)评定肘关节功能。结果 28例患者术后获8~25个月(平均18个月)随访,4例失访。所有患者骨折均获骨性愈合,愈合时间为6~18周,平均12.8周。末次随访时肘部屈曲活动度113°~128°,平均125°;肘部伸直活动度0°~30°,平均6°;前臂旋前54°~82°,平均75°;旋后69°~94°,平均81°。根据MEPS评分评定疗效,优20例,良4例,可2例,差2例,优良率为85.7%。所有患者均无伤口深部感染,2例患者出现肘关节僵硬。结论应用前后路联合手术治疗尺骨鹰嘴并冠状突骨折,可以有效复位及固定牢靠,有利于肘关节早期功能锻炼。     

Functional outcome following treatment of transolecranon fracture-dislocation of the elbow

Elbow fracture-dislocations are considered as difficult injuries to treat. Anterior olecranon fracture-dislocation consist an uncommon pattern which is likely to be under-diagnosed. Eight patients identified as anterior fracture-dislocation of the elbow were retrospectively reviewed. There were seven men and one woman with an average age of 35 years (range, 22-58 years). Proximal ulna fracture was comminuted in seven and simple oblique in one patient. Associated fractures were of coronoid in four and radial head in two. Reconstruction plate was used in seven patients and tension band wiring in just one. Nevertheless, tension wiring failed and was successfully revised to plate fixation combined with bone graft. Patients were followed for an average of 37.4 months (range, 10-50 months). The end results were two excellent, five good and one fair, based on Broberg and Morrey scale. An average score of 89 points was obtained using American Shoulder and Elbow Surgeons elbow scoring system. Treatment of anterior olecranon fracture dislocation is mostly satisfactory if contour and dimension of greater sigmoid notch is accurately restored.     

Olecranon fractures

Approximately 10% of fractures about the adult elbow consist of fractures of the olecranon process of the ulna and range from simple nondisplaced fractures to complex fracture-dislocations of the elbow. Several treatment options for internal fixation have been described, including tension-band wiring, plate fixation, intramedullary screw fixation, and triceps advancement after fragment excision. The method of internal fixation is chosen based primarily on fracture type. Because olecranon fractures are all intra-articular injuries, they require anatomic or essentially normal surface reduction and trochlear notch contour for predictable outcomes. In addition, fixation must be stable enough to permit early mobilization to avoid significant elbow stiffness. Given the variability in fracture patterns, the complex anatomy, and associated injuries, treating surgeons must be familiar with multiple treatment methods and follow a systematic surgical strategy to avoid complications and achieve reliable outcomes.     

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.     

Surgical treatment of persistent dislocation or subluxation of the ulnohumeral joint after fracture-dislocation of the elbow

PURPOSE: To review the results of surgical reconstruction of posttraumatic elbow instability in the setting of either intact or repaired olecranon process using a protocol incorporating hinged elbow fixation. METHODS: Thirteen consecutive patients with ulnohumeral instability after a fracture-dislocation of the elbow, adequate articular surfaces, and adequate, stable alignment of the olecranon were treated with temporary hinged external fixation, preservation, or reconstruction of both the coronoid process and radiocapitellar contact and with repair or reconstruction of the lateral collateral ligament complex. There were 9 men and 4 women with an average age of 45 years. Seven patients had a terrible triad pattern injury and 6 had a posterior Monteggia pattern injury. All 13 patients had fracture of the radial head and 10 patients had fracture of the coronoid process. RESULTS: At an average follow-up period of 57 months stability was restored in every patient. The average Disabilities of the Arm, Shoulder, and Hand questionnaire score was 15 and the average Mayo score was 84, with 6 excellent, 4 good, and 3 fair results. The average arc of ulnohumeral motion was 99 degrees. Six patients had radiographic signs of arthrosis including 5 of 6 patients with olecranon fracture-dislocations. CONCLUSIONS: A stable, functional elbow can be restored in most patients with persistent instability after fracture-dislocation of the elbow using a treatment protocol incorporating hinged external fixation.     

Chondromalacia of trochlear notch after healing of olecranon stress fracture: a case report

Introduction: Chondromalacia of the trochlear notch and stress fracture of olecranon are uncommon injuries in the throwing athletes. Materials and methods: We report an 18-year-old high school pitcher who had persistent postero-lateral elbow pain after a healed olecranon stress fracture of the right elbow. Diagnostic arthroscopy revealed chondromalacia of the trochlear notch. Results: After treatment with arthroscopic drilling and abrasion chondroplasty, he returned to competitive pitching 1 year later postsurgery. This rare association between chondromalacia and stress fracture of the olecranon has not been reported previously in the literatures. Conclusion: Chondromalacia of the trochlear notch should be included as a differential diagnosis in evaluating athletes with persistent elbow pain after healed olecranon stress fractures.     

Effective treatment of fracture-dislocations of the olecranon requires a stable trochlear notch

Our goal with this study was to better define and characterize fracture-dislocations of the olecranon and to provide additional data regarding complications and elbow function after operative treatment. Twenty-six patients with fracture-dislocations of the elbow were reviewed retrospectively. Ten had anterior and 16 had posterior fracture-dislocations. Five of 10 patients with anterior injuries and all of the patients with posterior injuries had an associated fracture of the coronoid process of the ulna. One of 10 patients with anterior and 13 of 16 patients with posterior injuries had fracture of the radial head. Only one patient had a true dislocation of the ulnohumeral joint. In the other 25 patients the articular surfaces remained apposed. All 26 patients were treated operatively and followed up for at least 3 years (average, 6 years). The results were good or excellent in 21 of 26 patients according to the system of Broberg and Morrey. The five unsatisfactory results were related to inadequate fixation of the coronoid with subsequent arthrosis (three patients), proximal radioulnar synostosis (three patients), and a subsequent fracture of the distal humerus (one patient). Fracture-dislocations of the olecranon occur in anterior and posterior patterns with specific injury characteristics and pitfalls. The key to effective treatment is stable restoration of the trochlear notch.     

双微型锁定钢板治疗尺骨鹰嘴骨折的疗效观察

目的:探讨双微型锁定钢板治疗尺骨鹰嘴骨折的临床疗效.方法:自2017年3月至2020年5月,采用双微型锁定钢板治疗19例尺骨鹰嘴骨折患者,其中男12例,女7例;年龄20～75(40.50±7.62)岁;左侧10例,右侧9例.19例患者均为新鲜闭合骨折且不合并尺骨冠状突骨折、肘关节脱位等损伤.记录患者骨折愈合时间及并发症...     

尺骨鹰嘴骨折不同程度骨量丢失对肘关节稳定性的影响

目的 探讨尺骨鹰嘴骨折时不同程度骨量丢失对肘关节稳定性的影响.方法 取10具20侧男性新鲜上技标本,在距尺骨鹰嘴尖部10 mm处向远端截骨,制备鹰嘴中部不同程度骨缺损,即骨量丢失模型,截骨分为4组,每组5侧上肢标本,即尺骨鹰嘴完整组、截除3mm组、截除6mm组、截除9 mm组,骨折断端予张力带内固定后,测量每组肘关节屈伸活动范围变化及肘关节在屈曲30°、60°、90°、120°时,前臂施加1.96 N·m扭距,肘关节内外翻角度的变化,同时观察肱尺关节关系.结果当尺骨鹰嘴截骨至3 mm时,肘关节的伸直活动开始受限;当尺骨鹰嘴截骨至6 mm时,CB片示肱尺关节出现不服贴,鹰嘴尖紧贴滑车关节面,滑车与鹰嘴之间间隙增大,肘关节的伸直活动明显受限;当尺骨鹰嘴截骨至9mm时,CR片示肘关节明显处于半脱位,滑车切迹的弧度基本消失.肘关节屈曲30°、60°、90°时,随截骨量增大肘外翻角度增大,当截骨量达到6 mm时外翻角度明显增大,差异有统计学意义(P＜0.05).而肘关节屈曲30°、60°、90°、120°时,内翻角度组间差异无统计学意义(P＞0.05).结论 尺骨鹰嘴中部截骨缩短达到6mm时,滑车切迹弧度发生改变,出现肘关节不稳定.临床对于尺骨鹰嘴中部粉碎性骨折如短缩不超过6 mm可单纯固定,否则应考虑原位植骨内固定.     

Complex coronal shear fractures of the distal humerus

This is a retrospective review of nine coronal shear fractures of the distal humerus. Two were isolated fractures and seven were associated with other peri-articular elbow injuries, termed "complex" coronal shear fractures. All cases underwent immediate open reduction and internal fixation (ORIF) and were then followed for an average of 14 months (range: 6.5 to 23 months) with outcomes evaluated using the Mayo Elbow Performance Scoring system. There was a significant difference found between injuries limited to the radiocapitellar (RC) joint (isolated coronal shear fractures, or those associated only with radial head fractures) and the complex injuries extending beyond the RC joint. Scores for the RC injuries were 100 and other complex injuries had an average score of 69 (range: 35 to 95; p = .025). All complications were limited to the group with the complex injuries, including stiffness, nonunion, pain, and gross instability. Much of the current thinking in treatment of this fracture was upheld in this study; computed tomography aids in diagnosis, ORIF is a necessity, and there is a need for anatomic reduction. When a coronal shear fracture is complicated by a concomitant injury outside the RC joint, both the surgeon's and patient's expectation need to be adjusted accordingly.     

不同类型尺骨近端骨折的内固定选择和疗效分析

目的探讨不同类型尺骨近端骨折的临床特点、内固定选择、手术策略和临床疗效。 方法回顾性分析2014年6月至2017年6月收治的45例尺骨近端骨折患者资料，男26例、女19例；年龄19~65岁，平均40.8岁；致伤原因：摔伤25例，高处坠落伤12例，交通伤8例。所有患者均行手术治疗，根据骨折的特点和类型分别选择克氏针张力带、解剖钢板或两者联合的方法固定骨折，恢复骨性结构的稳定性。合并尺骨冠状突骨折采用袢钢板固定。合并桡骨头骨折采用微型钢板固定或金属桡骨头置换。合并韧带损伤时均采用带线锚钉缝合固定修补。 结果45例患者获15.6个月（12~24个月）随访。随访结果：所有患者均获骨性愈合，愈合时间平均为11.2周（8~16周）。末次随访：肘部屈曲活动80°~135°，平均121°；肘部伸直活动0~30°，平均8°。Mayo肘关节功能评分为50~100分，平均88.2分，其中优26例，良15例，可2例，差2例，优良率为91.1％。 结论尺骨近端骨折形态各异，应该根据受伤机制、骨折特点及患者情况进行骨折严重程度的评估和分型，选择合理的内固定方式，积极进行术后康复，恢复良好的肘关节功能。