子母螺钉固定治疗Regan-MorreyⅡ型尺骨冠突骨折

目的 探讨子母螺钉固定治疗Regan-MorreyⅡ型尺骨冠突骨折的初期临床疗效.方法 回顾性分析2010年10月至2012年6月,采用子母螺钉固定治疗12例Regan-MorreyⅡ型尺骨冠突骨折患者资料,男8例,女4例；年龄19～69岁,平均42.3岁.其中9例合并桡骨头骨折,2例合并尺骨近端骨折,1例合并尺神经损伤,8例合并韧带损伤,7例合并肘关节脱位；7例诊断为肘关节恐怖三联征.先治疗桡骨头骨折,然后采用1枚子母螺钉固定治疗冠突骨折,最后复位肘关节及修复韧带损伤.采用Mayo肘关节功能评分(Mayo elbow performance score,MEPS)评估临床功能,以Broberg-Morrey影像学标准对骨关节炎进行分级.结果 12例患者均获得5～18个月随访,肘关节屈伸活动度平均为121.8°,旋转活动度为平均145.1°.MEPS评分为72～100分；优4例,良7例,可1例,优良率91.7％.术后2例(16.7％)有骨关节炎征象,其中Broberg-Morrey分级1级1例,2级1例.末次随访时1例发生轻度异位骨化.肘关节均得到解剖复位；骨折均愈合,愈合时间1.8～3.4个月.1例尺神经损伤患者术后3个月完全恢复.术后无一例发生继发性关节脱位、内固定松动、移位或断裂、感染及行二次手术.结论 采用切开复位子母螺钉固定治疗Regan-MorreyⅡ型尺骨冠突骨折,术后肘关节功能恢复良好,并发症少.

Child-mother screw for fixation of Regan-Morrey type II coronoid process fracture

Objective To evaluate the preliminary clinical effect of child-mother screw for fixation of Regan-Morrey type II coronoid process fracture. Methods Data of 12 patients who had undergone open reduction and internal fixation with child-mother screw for Regan-Morrey type II coronoid process fracture from October 2010 to June 2012 were retrospectively analyzed, including 8 males and 4 females, aged from 19 to 69 years (average, 42.3 years). Ten patients had associated injuries, including radial head fracture in 9 patients, proximal ulnar fracture in 2 patients, ligament injury in 8 patients, ulnar never injury in 1 patient and elbow dislocation in 7 patients. The so-called terrible triad injury was found in 7 patients. The Mayo Elbow Performance Score (MEPS) and the Broberg-Morrey criteria were used to assess clinical outcome and signs of arthritis, respectively. Results All the patients were followed up for 5 to 18 months. The flexion-extension arc of the elbow averaged 121.8°, and forearm rotation averaged 145.1°. The MEPS ranged from 72 to 100 points, the result was excellent in 4 patients, good in 7, and fair in 1, and the excellent and good rate was 91.7%. According to the Broberg-Morrey criteria, 2 patients (16.7%) showed signs of posttraumatic arthritis, including 1 case of grade 1 and 1 case of grade 2. At the final follow-up, mild heterotopic ossification occurred in 1 patient. All fractures achieved bone union, and the healing time ranged from 1.8 to 3.4 months. Ulnar nerve function returned to normal in 1 patient with ulnar nerve injury 3 months after operation. All patients achieved concentric reduction. No infection, secondary dislocation of joint, loosening or breakage of the implant occurred, and no patient required reoperation. Conclusion Open reduction and internal fixation with child-mother screws for Regan-Morrey type II coronoid process fracture can restore sufficient elbow stability, enhance the functional outcome and reduce complications.