Feng Dongxu, Zhang Xin, Jiang Yonghong, Zhu Yangjun, Wang Hao, Wu Shufang, Zhang Kun, Wang Zhan, Zhang Jun
Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine Center for Translational Medicine, the First Affiliated Hospital of Xi'an Jiaotong University School of Medicine Shaanxi Provincial People's Hospital Image Center, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, China.
Medicine (Baltimore). 2018 Sep;97(36):e12041. doi: 10.1097/MD.0000000000012041.
Coronoid process fractures of the ulna are difficult to treat, and are associated with stiffness, recurrent instability, and pain. Hence, treatment of coronoid process fractures are challenging for surgeons. The purpose of this study was to report the clinical outcomes of an anterior surgical approach associated with plate fixation for Regan and Morrey type II or type III fractures of the coronoid process.We evaluated 16 consecutive patients who underwent surgical treatment for fracture of the coronoid process of the ulna from March 2012 to July 2016. Ten patients had a type II fracture, and 6 patients had a type III fracture. All patients underwent surgical treatment for coronoid process fracture through an anterior approach. While preserving the neurovascular structure, all fractures were treated with buttress plate fixation, maintaining the gap between brachial artery and median nerve. Each patient was treated with concentric reduction of both the ulnotrochlear and the radiocapitellar articulations, without any evidence of elbow instability, except 1 case, who showed some medial instability.At the final follow-up, solid osseous union was confirmed for all coronoid fractures. The average time to radiologic union was 16.3 weeks. The mean flexion-extension arc was 124.25 ± 12.12 degree, with a mean flexion contracture of 8.25 ± 4.36 degree, and further flexion of 132.5 ± 9.31 degree. The mean forearm rotation arc was 167.81 ± 10.49 degree. Fifteen patients achieved a functional arc of motion. The mean Mayo elbow performance score was 92.1 points, with 12 excellent cases and 4 good cases.Coronoid process fractures of the ulna can be treated successfully with plate fixation through an anterior surgical approach, which allows for accurate reduction and rigid internal fixation and early functional exercise, resulting in a reasonable outcome.
尺骨冠状突骨折难以治疗，且与关节僵硬、反复性不稳定及疼痛相关。因此，对于外科医生而言，治疗冠状突骨折颇具挑战性。本研究的目的是报告一种前路手术入路联合钢板固定治疗Regan和Morrey II型或III型冠状突骨折的临床疗效。我们评估了2012年3月至2016年7月期间连续接受尺骨冠状突骨折手术治疗的16例患者。其中10例为II型骨折，6例为III型骨折。所有患者均通过前路入路接受冠状突骨折的手术治疗。在保留神经血管结构的同时，所有骨折均采用支撑钢板固定，保持肱动脉与正中神经之间的间隙。除1例表现为内侧轻度不稳定外，其余患者均通过尺骨滑车关节和桡骨头关节的同心复位进行治疗，未出现肘关节不稳定的迹象。在末次随访时，所有冠状突骨折均证实获得牢固的骨愈合。放射学愈合的平均时间为16.3周。平均屈伸弧度为124.25±12.12度，平均屈曲挛缩为8.25±4.36度，进一步屈曲为132.5±9.31度。平均前臂旋转弧度为167.81±10.49度。15例患者达到了功能活动弧度。Mayo肘关节功能评分平均为92.1分，其中优12例，良4例。尺骨冠状突骨折通过前路手术入路联合钢板固定可成功治疗，该方法能够实现精确复位、坚强内固定及早期功能锻炼，从而获得较为理想的治疗效果。
