Cage D J, Abrams R A, Callahan J J, Botte M J
Department of Orthopedics, University of California, San Diego 92103, USA.
Clin Orthop Relat Res. 1995 Nov(320):154-8.
Regan and Morrey proposed a 3-type coronoid fracture classification observing that the incidence of concommitant elbow dislocation was proportional to fragment size. Elbow instability associated with coronoid fractures presumably is related to disrupted bony architecture and ineffective stabilizers attached to the free fragment. Twenty cadaveric elbows were dissected, measuring medial collateral ligament, anterior capsule, and brachialis muscle insertion loci on the coronoid. Radiographs were taken after radiopaque labeling of the stabilizer insertions. The anterior bundle of the medial collateral ligament insertion averaged 18.4 mm dorsal to the coronoid tip. Only in Type III fractures would it be attached to the free fragment. The capsule inserted an average of 6.4 mm distal to the coronoid tip. Rarely should Type I fractures result from a capsular avulsion, because only 3 of 20 specimens had the capsule inserting on the tip. The brachialis had a musculoaponeurotic insertion onto the elbow capsule, coronoid, and proximal ulna. The bony insertion averaged 26.3 mm in length, with its proximal margin averaging 11 mm distal to the coronoid tip. In only Type III fractures is the fragment large enough to include the brachialis bony insertion.
里根和莫里提出了一种冠状突骨折的三型分类法，他们观察到合并肘关节脱位的发生率与骨折块大小成正比。与冠状突骨折相关的肘关节不稳定可能与骨结构破坏以及附着于游离骨折块的稳定结构失效有关。对20个尸体肘关节进行解剖，测量内侧副韧带、前关节囊以及肱肌在冠状突上的附着位点。在对稳定结构附着点进行不透射线标记后拍摄X线片。内侧副韧带前束附着点平均位于冠状突尖背侧18.4毫米处。只有在Ⅲ型骨折中，它才会附着于游离骨折块。关节囊附着点平均位于冠状突尖远侧6.4毫米处。Ⅰ型骨折很少由关节囊撕脱引起，因为20个标本中只有3个标本的关节囊附着于冠状突尖。肱肌通过肌腱膜附着于肘关节囊、冠状突和尺骨近端。其骨性附着长度平均为26.3毫米，近端边缘平均位于冠状突尖远侧11毫米处。只有在Ⅲ型骨折中，骨折块才大到足以包含肱肌的骨性附着点。
