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尺骨鹰嘴骨折合并肘关节前脱位的手术治疗 |
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蒋协远 王满宜 黄强 荣国威
【摘要】目的应用内固定治疗尺骨鹰嘴骨折合并肘关节前脱位。方法对15例资料完整的病例进行回顾性分析。其中男10例，女5例；年龄22～48岁，平均38岁。车祸伤9例，高处坠落伤6例。开放性损伤3例，闭合性损伤12例。尺骨鹰嘴粉碎性骨折14例，斜形骨折1例。13例合并冠状突骨折，2例合并肱骨外髁骨折。对所有病例应用内固定治疗，包括单纯张力带固定4例，张力带加螺钉固定5例，张力带加重建钢板或半管状钢板固定6例。3例行一期植骨。结果术后平均随访18个月。肘关节和前臂平均活动范围：屈肘105°，伸肘－20°；前臂旋前50°，旋后60°。按照Broberg和Morrey评估标准进行评价，优8例，良6例，可1例。其中张力带加钢板治疗组6例均为优。结论高能量损伤中因尺骨近端多为粉碎性骨折，且多同时合并冠状突骨折，肘关节极不稳定，单纯应用张力带固定不能获得稳定的固定，建议用重建钢板对尺骨近端骨折进行稳定固定，以获得正常的鹰嘴宽度和肱尺关节对合关系。一旦尺骨骨折向前移位得到纠正，桡骨头脱位也大多同时得到复位。存在明显骨缺损者应一期植骨。
【关键词】尺骨骨折；肘关节；脱位；内固定器
Operative treatment of olecranon fracture associated with anterior dislocation of the elbow
JIANG Xieyuan, WANG Manyi, HUANG Qiang， et al.
（Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China）
【 Abstract】 Objective To report the results of treatment of olecranon fracture combined with anterior dislocation of the elbow by internal fixation. Methods 15 cases with complete records were reviewed, 10 of them were male and 5 were female, with an average age of 38 years. 9 fracture-dislocations were caused by traffic accident, 6 by fall from heights. 3 were opened injuries and 12 were closed. Comminuted fractures were found in 14 and oblique fracture in 1. Coracoid process fractures were found in 13 and lateral humeral condyle fractures in 2. Internal fixation had been adopted in all 15 cases: 4 with single tension band wiring, 5 with tension band and screw fixation and 6 with tension band and reconstruction plate or semitubular plate fixation. Bone graft had been done in 3 during the primary procedure. Results The mean duration of the follow-up was 18 months. Bone healing was seen at 3－ 4 months in the 12 closed cases, and at 5 months in the opened cases. The mean range of motion of the elbow and forearm was 105° in flexion,－ 20° in extension, 50° in pronation and 60° in supination. According to Broberg ＆ Morrey s evaluation method, 8 pati[1] [2] [3] 下一页
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