关节镜下尺骨鹰嘴窝、冠突窝成形术治疗肘关节屈伸活动受限

目的 对肘关节屈伸活动受限患者关节镜下行尺骨鹰嘴窝、冠突窝成形手术疗效的探讨.方法 2009年11月～2010年12月选择肘关节屈伸活动受限患者17例,行关节镜下尺骨鹰嘴窝、冠突窝成形术,术后随访6～8个月,测定术前、术后的肘关节最大伸曲角度,以Mayo肘关节评分评价肘关节功能.结果 患者肘关节疼痛明显缓解或消失,关节...     

使用重建钢板手术治疗尺骨鹰嘴骨折

目的 评价重建钢板治疗尺骨鹰嘴骨折的临床疗效。方法对31例尺骨鹰嘴骨折采用重建钢板进行切开复位内固定治疗,并对肘关节功能进行评价。结果所有病人皆获得了随访．随访时间6-12个月（平均8个月）,根据HSS美国特种外科医院临床评分标准：优16例,良11例,一般3例,较差1例,优良率87．1％。结论对于大块型尺骨鹰嘴骨折,重建钢板内固定可获得非常满意的效果。     

切开复位钢板内固定治疗尺骨鹰嘴粉碎性骨折疗效观察

目的：通过影像学和临床效果评价,探讨切开复位钢板内固定治疗尺骨鹰嘴粉碎性骨折的临床效果。方法2005年6月-2011年6月,我院应用切开复位钢板内固定治疗尺骨鹰嘴粉碎性骨折患者21例,对所有病例进行临床和影像学评价。平均随访时间18个月。结果患者骨折均获得愈合,平均愈合时间5.2个月,根据Broberg-Morrey评分标准,优5例,良9例,一般6例,差1例。1例因肘关节僵硬在内固定取出同时行肘关节松解,评分一般和差者均为合并肘关节其他损伤病例。结论切开复位钢板内固定尺骨鹰嘴粉碎性骨折是一种安全有效的治疗方法,允许肘关节早期活动;但如合并有肘关节其他损伤,则肘关节活动受限的危险性较高。     

Outcomes after plating of olecranon fractures: A multicenter evaluation

IntroductionThe aim of this study was to report the physical and functional outcomes after open reduction internal fixation of the olecranon in a large series of patients with region specific plating across multiple centres.Patients/methodsBetween January 2007 and January 2014, 182 consecutive patients with a displaced olecranon fracture treated with open reduction internal fixation were included in this study. Retrospective review across four trauma centres collected elbow range of motion, DASH scores, hardware complications, and hardware removal. Postoperative visits in the outpatient clinic were at two, six, and twenty-four weeks. After 24 weeks, patients were eligible for hardware removal if symptomatic. All patients were contacted, at least 1 year following surgery, to determine if hardware was removed.Results182 patients (75 women, 105 men) average age 50 (16–89) with 162 closed and 19 open displaced olecranon fractures were treated with one region specific plate. Nineteen were lost to followup leaving 163 for analysis with all patients united. The most common deficiency was a lack of full extension with 39% lacking at least 10° of extension. Hardware was asymptomatic in 67%, painful upon leaning in 20%, and restricted activities in 11% resulting in a 15% rate of hardware removal. Hardware complaints were more common if a screw was placed in the corner of the plate (P = 0.004). When symptomatic, the area of the plate that was bothersome encompassed the whole plate in 39%, was at the edge of the plate in 33%, and was a screw head in 28%. The DASH scores, collected at final follow-up of 24 weeks, was 10.1 ± 16, indicating moderate disability was still present. Patients who lacked 10° of extension had a DASH of 12.3 as compared with 10.5 for those with near full extension, but this was not significant (P = 0.5).ConclusionPlating of the olecranon leads to predictable union. The most common complication was lack of full extension with 39% lacking more than 10°, although this did not have any effect on DASH scores. Overall results indicate that disability still exists after 6 months with an average DASH score of 10.Level of evidenceTherapeutic level III.     

AO解剖型锁定加压板治疗肱骨远端C型骨折

目的探讨AO解剖型锁定加压板治疗肱骨远端C型骨折的疗效。方法 2008年7月-2009年4月,经尺骨鹰嘴截骨入路、AO解剖型锁定加压板治疗13例肱骨远端C型骨折。男5例,女8例;年龄24～80岁,平均52.1岁。摔伤7例,车祸伤4例,高处坠落伤2例。骨折按内固定研究协会/美国骨创伤协会(AO/OTA)分型标准分型:C1型3例,C2型6例,C3型4例。合并尺神经损伤2例,桡神经损伤1例;合并尺骨鹰嘴骨折2例,四肢其他骨折3例;合并骨质疏松6例。受伤至入院时间为3h～4d,平均0.9d。结果术后切口均Ⅰ期愈合。13例均获随访,随访时间12～21个月,平均15.9个月。X线片检查示骨折与鹰嘴截骨均于术后8～13周愈合,平均10周。肘关节功能均于术后3～32周恢复,平均10周。无内固定失败、骨化性肌炎、畸形愈合及延迟愈合、不愈合发生。末次随访时根据Mayo肘关节评分标准评分为75～100分,平均95.8分;获优9例,良3例,一般1例,优良率92.3%。结论经尺骨鹰嘴截骨入路、AO解剖型锁定加压板治疗肱骨远端C型骨折,具有内固定坚强,可以早期功能锻炼的优点,术后疗效满意。     

Skeletal age assessment from elbow radiographs. Review of the literature

Skeletal age is important to evaluate remaining growth. In 50% of normal children and adolescents, skeletal age does not differ from chronological age. During puberty, skeletal age is an important tool when performing a lower limb epiphysiodesis or when treating (conservatively or surgically) patients with spinal deformities. Skeletal age alone is not enough and should be assessed together with other clinical and radiological findings such as standing and sitting heights, Risser sign, Tanner stages and annual growth rate. Puberty starts at 11 years of skeletal age and ends at 13 years of skeletal age in girls; in boys, puberty starts two years later (13 years of skeletal age) and then ends at a skeletal age of 15. Most current clinical and radiographic markers do not help paediatric orthopaedic surgeons to clearly distinguish maturity levels prior to Risser I. Sauvegrain et al. developed a method to assess skeletal age by using elbow radiographs (AP and lateral projections). Between 11 and 13 years of skeletal age in girls and between 13 and 15 years of skeletal age in boys, the olecranon apophysis is characterised by a clear morphological development. This method is a reliable tool to assess skeletal age during puberty because significant morphological changes in the elbow happen every six months.     

Free-hand versus novel specialised jig guidance for the passing of intramedullary wires in olecranon fracture fixation: A comparative study

The treatment of olecranon fractures frequently involves the use of tension-band fixation. Although associated with high union rates, this method has a high incidence of morbidity associated with soft tissue compromise and limitation of range of movement requiring frequent re-operation for removal of metal.We describe the use of a simple jig to ensure intramedullary placement of longitudinal K-wires and compare the accuracy of placement of Kirschner (K)-wires using this device with the traditional free-hand method.We found the distance from the centre of the medullary canal, the range and standard deviations of K-wire positions to be significantly more precise when the jig was used. This has applications for the use of the device, both with standard metallic radio-opaque wires and potentially with bio-absorbable pins.