尺骨冠突骨折分型及疗效分析.docVIP

尺骨冠突骨折分型及疗效分析 　【摘要】 [目的]探讨尺骨冠突骨折的分型及治疗方法。[方法]对54例尺骨冠突骨折患者，根据尺骨冠突骨折线的位置、尺侧副韧带是否损伤、冠突受损程度及肘关节稳定性的影响分为4型。[结果]患者伤口均Ⅰ期愈合，骨折愈合率为100%。术后随访16～72个月，平均27.9个月。无1例发生感染、神经损伤和肘关节不稳定，但Ⅲ型1例、Ⅳ型2例有创伤性关节炎表现，Ⅳ型骨折患者术后患侧肘关节活动范围明显小于健侧(Plt;0.05)。[结论]Ⅰ型冠突骨折可行保守治疗，若骨折片移位突入关节间隙影响肘关节活动，可手术摘除碎骨片;Ⅱ、Ⅲ型冠突骨折可行切开复位内固定，同时注意修补或重建韧带以稳定肘关节;Ⅳ型冠突骨折，应重建冠突及尺侧副韧带前束，并保持冠突的高度达到原高度的1/2以上，同时加强术后功能锻炼。 【关键词】 尺骨骨折; 肘关节; 关节不稳定性 　　Abstract：[Objective]To explore the method of treatment and classifications of fracture of the corocoid process of ulna.[Method]There were 56 cases of fracture of the corocoid process of ulna,with average 28.16 years old.The classifications of the corocoid process were based on the location of fracture,injury of the collateral ulnar ligament,degree of injury of the corociod process and stability of the elbow joint.[Result]All the patients were in the first intention with healing rate of 100%.The following period were 16-72 months (27.9 months on average).No complications had happened in infection,injury of nerves and instability of the elbow joints.However,there were changes of traumatic arthritis in a case of type 3 and 2 cases of type 4.The activity of the elbow joint reduced remarkably comparing with the healthy side in type 4 (Plt;0.05).[Conclusion]The fracture of the corociod process can be disposed in conservative treatment in type 1.If bone chips move into the intraarticular spaces and affect the movement of the affected elbow joints,these should be removed through operation.In type 2 and type 3,the cases should receive open reduction and fixation repair and reconstruction of ligaments for stability of the elbow joint.For type 4,the structures should be reconstructed in the corocoid process and anterior bundle of the collateral ulnar ligaments.The height of the corocoid process should be kept in more than half of its original height with functional practice after operation. 　　Key words：fracture of ulna; elbow joint; instability of joint 　　尺骨冠突骨折常合并肘关节脱位及肘部骨折，临床上并不少见。常见报告15%肘关节位脱位患者可合