CAJ | 학술논문

背景：临床上冠状突骨折多发生于伴有肘关节脱位的患者，并伴随有肘关节侧副韧带、关节囊的撕裂伤，常会导致肘关节失稳，如不能得到恰当处置会发生肘关节反复失稳、脱位，并对肘关节造成远期不可逆损害。目的：回顾近年来关于冠状突骨折修复方法及相关解剖生物力学的研究进展。方法：计算机检索Web of Science数据库于1990年1月至2013年3月有关冠状突骨折及冠状突解剖生物力学的临床与试验研究，检索词分别为“coronoid process of the ulna,coronoid fracture,treatment method, research progress”，排除发表时间较早或重复研究文献。结果与结论：尺骨冠状突是肘关节重要的骨性稳定结构，它与附丽在其上的韧带、关节囊和肌肉等软组织结构在维持肘关节轴向、内翻、外翻和旋转稳定性上发挥着重要作用。冠状突骨折治疗方案的选择与骨折分型、骨折块粉碎程度、内外侧副韧带及前关节囊的损伤情况密切相关。大块非粉碎性骨折可给予切开复位内固定；粉碎性骨折可选取较大骨折块给予复位固定，自体骨移植冠状突重建或人工冠状突置换；小块冠状突骨折的修复与否则视情况而定：若软组织损伤修复完成后，肘关节获得足够稳定性则冠状突骨折不予以处理，相反则可予以锚钉或缝线修复。治疗后早期活动是获得良好功能的关键，必要时可给予铰链式外固定支架固定。
배경：림상상관상돌골절다발생우반유주관절탈위적환자，병반수유주관절측부인대、관절낭적시렬상，상회도치주관절실은，여불능득도흡당처치회발생주관절반복실은、탈위，병대주관절조성원기불가역손해。목적：회고근년래관우관상돌골절수복방법급상관해부생물역학적연구진전。방법：계산궤검색Web of Science수거고우1990년1월지2013년3월유관관상돌골절급관상돌해부생물역학적림상여시험연구，검색사분별위“coronoid process of the ulna,coronoid fracture,treatment method, research progress”，배제발표시간교조혹중복연구문헌。결과여결론：척골관상돌시주관절중요적골성은정결구，타여부려재기상적인대、관절낭화기육등연조직결구재유지주관절축향、내번、외번화선전은정성상발휘착중요작용。관상돌골절치료방안적선택여골절분형、골절괴분쇄정도、내외측부인대급전관절낭적손상정황밀절상관。대괴비분쇄성골절가급여절개복위내고정；분쇄성골절가선취교대골절괴급여복위고정，자체골이식관상돌중건혹인공관상돌치환；소괴관상돌골절적수복여부칙시정황이정：약연조직손상수복완성후，주관절획득족구은정성칙관상돌골절불여이처리，상반칙가여이묘정혹봉선수복。치료후조기활동시획득량호공능적관건，필요시가급여교련식외고정지가고정。
BACKGROUND:Fractures of the coronoid progress are common in patients with elbow dislocations, and often accompanied by elbow ligament and joint capsule laceration. The coronoid progress fracture often leads to elbow joint instability, if cannot get the correct therapy, wil result in repeatedly elbow instability, dislocation, and cause long-term irreversible damage to the elbow. OBJECTIVE:To review the literatures about coronoid fractures and relative anatomic and biomechanical studies. METHODS:An electronic search of the Web of Science database was conducted for clinical and experimental researches about coronoid fractures and relative anatomic and biomechanics published from January 1990 to March 2013, the key words were“coronoid process of the ulna, coronoid fracture, treatment method, research progress”. The articles published earlier and repetitive researches were excluded. RESULTS AND CONCLUSION:Coronoid process is an important primary stabilizer of elbow joint, The coronoid process combined with the soft tissues of ligaments, joint capsule and muscles that attached on the coronoid plays an important role in maintaining the elbow axial, varus, valgus and rotation stability. The selection of the treatment strategies for coronoid process fracture depends on the fracture type, degree of fracture fragments crush and injury of medial and lateral col ateral ligament and the anterior capsule. Uncomminuted large fractures can be treated with open reduction and internal fixation;comminuted fractures can be treated with reduction and internal fixation by the largest fracture fragments, autograft reconstruction or artificial coronoid process replacement;the repair of smal coronoid process fracture depends on the circumstances;if the elbow gets enough stability after repair of soft tissue injury, it cannot be addressed, if not, the elbow should be repaired with sutures or anchors. Earlier motion after operation is important to get better function, and the hinged external fixator can be used if necessary.