【摘要】：背景:生物力學(xué)及臨床性研究均已證明冠狀突是肘關(guān)節(jié)穩(wěn)定性的重要組成部分。冠狀突是阻止尺骨向后側(cè)移位的前方支撐,同時(shí)冠狀突亦是肘關(guān)節(jié)前方關(guān)節(jié)囊及內(nèi)側(cè)副韌帶前束的附著點(diǎn),冠狀突的骨性結(jié)構(gòu)及周圍韌帶組織的完整性均對(duì)肘關(guān)節(jié)的穩(wěn)定是重要的。此類損傷應(yīng)獲得手術(shù)治療。對(duì)于冠狀突骨折手術(shù)治療方案,因其解剖位置的復(fù)雜性及特殊性,在顯露冠狀突的最佳手術(shù)入路上尚無(wú)統(tǒng)一的意見及方案。目的:回顧性研究吉林大學(xué)中日聯(lián)誼醫(yī)院尺骨冠狀突骨折手術(shù)治療的臨床療效分析,探討尺骨冠狀突骨折的手術(shù)入路的選擇方案,內(nèi)固定物的應(yīng)用,以及術(shù)后患者康復(fù)情況。方法:選擇2014年至2016年吉林大學(xué)中日聯(lián)誼醫(yī)院診治的尺骨冠狀突骨折患者17例,男15例,女2例;年齡22~47歲,平均33.5歲;左側(cè)13例,右側(cè)4例;致傷原因:高處墜落傷5例,跌倒4例,車禍傷7例。尺骨冠狀突骨折塊根據(jù)O’Driscoll分型,行相應(yīng)的手術(shù)治療17例,其中,螺釘固定7例,鋼板固定10例。通過肘關(guān)節(jié)前側(cè)入路切口來(lái)顯露冠狀突,同時(shí)探查及修復(fù)內(nèi)側(cè)副韌帶及關(guān)節(jié)囊。對(duì)所有患者均定期予以術(shù)后隨訪,全部病例平均隨訪約14.11個(gè)月。在末次隨訪過程時(shí),觀察并測(cè)量肘關(guān)節(jié)的屈伸及旋前、旋后活動(dòng)度,用MAYO(Mayo elbow performance score)肘關(guān)節(jié)功能評(píng)分系統(tǒng)來(lái)評(píng)價(jià)患者肘關(guān)節(jié)功能恢復(fù)情況。結(jié)果:所有在本回顧性研究中患者均隨訪8~23個(gè)月,平均時(shí)間達(dá)到14.1個(gè)月左右,隨訪患者切口均愈合,無(wú)感染情況,術(shù)后骨折全部獲得臨床愈合,平均愈合時(shí)間12周左右,手術(shù)患者根據(jù)Mayo評(píng)分評(píng)價(jià),優(yōu)9例,良8例,中0例,差0例。數(shù)據(jù)整理后,根據(jù)骨折類型Ⅰ型,Ⅱ型,Ⅲ型,分別將肘關(guān)節(jié)活動(dòng)范圍與健側(cè)相比較,采用x±s,組間配對(duì)t檢驗(yàn),計(jì)算P值,有意義的標(biāo)準(zhǔn)為P0.05。肘關(guān)節(jié)活動(dòng)度詳見表。平均MEPS評(píng)分為92.5分,所有患者的肘關(guān)節(jié)功能恢復(fù)良好,恢復(fù)其穩(wěn)定性。結(jié)論:通過對(duì)吉林大學(xué)中日聯(lián)誼醫(yī)院的17例患者的回顧性分析,并查閱國(guó)內(nèi)外文獻(xiàn),可以得出下列結(jié)論:1、大部分尺骨冠狀突骨折患者需手術(shù)治療,恢復(fù)肘關(guān)節(jié)的解剖結(jié)構(gòu),修復(fù)損傷的內(nèi)、外側(cè)副韌帶。術(shù)后醫(yī)師指導(dǎo)下進(jìn)行有效、合理的功能練習(xí),有利于術(shù)后肘關(guān)節(jié)功能恢復(fù)。2、冠狀突骨折手術(shù)治療中,肘關(guān)節(jié)前側(cè)入路具有顯露充分,安全系數(shù)高,損傷較小,利于肘關(guān)節(jié)功能恢復(fù),臨床效果滿意。3.選擇合適內(nèi)固定物對(duì)于骨折復(fù)位及術(shù)后功能練習(xí)具有重要意義。
[Abstract]:Background: the coronal process has been proved to be an important component of elbow stability in biomechanical and clinical studies. The coronal process is the front support to prevent the ulna from moving to the posterior side, and the coronal process is also the attachment point of the anterior articular capsule and the anterior bundle of medial collateral ligament of the elbow joint. The osseous structure of the coronal process and the integrity of the surrounding ligaments are important for the stability of the elbow joint. Such injuries should be treated surgically. Because of the complexity and particularity of the anatomical location, there is no uniform opinion and scheme on the best surgical approach to expose the coronal process for the surgical treatment of coronal process fracture. Objective: to study retrospectively the clinical curative effect of surgical treatment of ulnar coronoid process fracture in Sino-Japanese Friendship Hospital of Jilin University, and to discuss the choice of operative approach, the application of internal fixation, and the postoperative rehabilitation of the patients with ulnar coronal process fracture. Methods: from 2014 to 2016, 17 patients (15 males and 2 females) with fracture of the ulna coronal process, aged 2247 years (mean 33.5 years), left side (13 cases) and right side (4 cases), were selected and treated by Sino-Japanese Friendship Hospital of Jilin University. 4 cases fell and 7 cases were injured in traffic accident. According to O'Driscoll classification, 17 cases of ulnar coronal process fracture were treated with screw fixation in 7 cases and plate fixation in 10 cases. The coronal process was exposed through the anterior approach of elbow joint, and the medial collateral ligament and joint capsule were explored and repaired. All patients were followed-up regularly, all patients were followed up for an average of 14.11 months. During the last follow-up, the flexion, extension, pronation and pronation of elbow joint were observed and measured. The functional recovery of elbow joint was evaluated by MAYO (Mayo elbow performance score) elbow function scoring system. Results: all the patients were followed up for 8 ~ 23 months, the average time was about 14.1 months. All the patients were healed without infection, and all the fractures were healed clinically, the average healing time was about 12 weeks. According to Mayo score, 9 cases were excellent, 8 cases were good, 0 cases were moderate and 0 cases were poor. According to the fracture type 鈪，

本文編號(hào)：2177465