锁定钢板治疗尺骨冠状突骨折

摘要

目的 探讨2,5 mm锁定钢板治疗尺骨冠状突骨折的效果.方法 自2012年7月至2013年7月我们共收治13例尺骨冠状突骨折患者,术前行影像学检查,包括肘关节X线正侧位片、CT平扫及三维重建,以明确骨折移位情况及骨折类型.根据O'Driscoll分型,Ⅰ型5例,Ⅱ型6例,Ⅲ型2例.所有患者均为新鲜闭合骨折,无神经、血管损伤.手术采用内侧人路8例,后正中入路5例,锁定钢板固定尺骨冠状突骨折.末次随访时记录患者的骨折愈合时间,使用Mavo肘关节评分(Mayo elbow performance score,MEPS)对肘关节功能进行评价.结果 术中患者肘关节均得到解剖复位,无骨折固定失效发生,无一例行尺骨冠状突切除或植骨重建.术后所有患者均获得随访,时间为24～31个月,平均27.2个月.术后冠状突骨折均顺利骨性愈合,时间为8～14周,平均9.6周.按MEPS评分标准,平均为89.2分.肘关节屈伸活动度平均118.8°,旋转活动度平均141.9°.本组4例出现骨关节炎征象,根据Broberg-Morrey标准,其中1级3例,2级1例.结论 锁定钢板治疗尺骨冠状突骨折具有较佳的固定效果,近期疗效满意.%Objective To evaluate the clinical outcomes of locking plate fixation for coronoid process fractures.Methods Thirteen patients with a coronoid process fracture were included in the study.According to O'Driscoll classification,there were five type-Ⅰ fractures,six type-Ⅱ fractures and two Type-Ⅲ fractures.Locking plate fixation via a medial approach in 8 cases and a posterior approach in 5 cases were performed within four days of the injury.Clinical,radiographic,and the Mayo Elbow Performance Score (MEPS) evaluations were conducted postoperatively.Results The follow-up time ranged from 24 to 31 months,with a mean of 27.2 months.All fractures healed at an average of 9.6 weeks (range,8 to 14 weeks).The mean MEPS was 89.2 points (range,75 to 100).Average range of motion was 118.8° for flexion-extension and 141.9° for pronation-supination.According to the Broberg-Morrey criteria,the signs of posttraumatic arthritis were observed in 4 patients,including 3 cases of grade 1 and 1 case of grade 2.No patient reported pain or had any subjective complaints consistent with elbow instability.Conclusion Locking plate fixation for coronoid process fracture followed by early rehabilitation can lead to functional range of motion and satisfactory outcomes.