2种方法治疗尺骨鹰嘴骨折合并肘关节前脱位的疗效比较

目的探讨解剖钢板内固定和张力带内固定治疗尺骨鹰嘴骨折合并肘关节前脱位的疗效。方法将39例尺骨鹰嘴骨折合并肘关节前脱位患者按随机数字表法分为2组,解剖钢板内固定组18例,采用解剖钢板内固定治疗;张力带内固定组21例,采用张力带内固定治疗。对2组的疗效进行比较。结果 39例患者均顺利完成手术,伤口均一期愈合,术后获7～19个月的随访,无骨折移位及骨不愈合。按美国特种外科医院（HSS）肘关节功能评价标准进行评定,解剖钢板内固定组优9例,良7例,可2例,优良率为88.9%;张力带内固定组优7例,良8例,可5例,差1例,优良率为71.4%,2组比较差异有统计学意义（P〈0.05）。结论解剖钢板内固定因具有固定牢靠、最大限度地恢复尺骨鹰嘴半月切迹与肱骨关节面的对合关系等优点,避免了术后鹰嘴变窄和短缩,并能早期进行患肘关节功能锻炼,故更适合尺骨鹰嘴骨折合并肘关节前脱位的治疗。

Comparison of Two Therapeutic Methods for Olecranon Fracture Associated with Anterior Dislocation of Elbow Joint

Objective To compare the effects of olecranon plate fixation and tension band fixation on olecranon fracture associated with anterior dislocation of elbow joint.Methods Thirty-nine patients with olecranon fracture associated with anterior dislocation of elbow joint were randomly assigned to receive either olecranon plate fixation（olecranon plate group,n=18） or tension band fixation（tension band group,n=21）.The curative effects were compared between the two groups.Results All 39 patients underwent operations successfully and achieved primary incision healing.After 7 to 19 months of follow-up,no fracture displacement and nonunion were observed.According to the criteria of Hospital for Special Surgery,the outcome was excellent in 9 patients,good in 7 and fair in 2 in olecranon plate group,and excellent in 7,good in 8,fair in 5 and bad in 1 in tension band group.The excellent and good rate in olecranon plate group was significantly higher than that in tension band group（88.9% vs 71.4%,P〈0.05）.Conclusion Olecranon plate can provide stable fixation for olecranon fracture,recover the apposition of semilunar notch and humeral articular surface,prevent postoperative narrowing and shortening of olecranon,and allow early functional exercise.Therefore,olecranon plate fixation is more feasible than tension band fixation for olecranon fracture associated with anterior dislocation of elbow joint.