CAJ | 학술논문

目的：探讨角稳定原则结合关节面下支撑治疗关节面粉碎的尺骨鹰嘴骨折的疗效。方法回顾性分析2008年11月至2012年6月，采用Synthes解剖锁定加压钢板结合关节面下克氏针固定治疗13例关节面粉碎的尺骨鹰嘴骨折患者资料，男7例，女6例；年龄20~77岁，平均52岁；左侧9例，右侧4例。Mayo分型：ⅡB型11例，ⅢB型2例；Schatzker-Schmeling分型：A2型2例，C型9例，D型2例，其中C型骨折中1例伴Ⅰ型冠状突骨折（Regan和Morrey分型）。使用Mayo肘关节评分指数（Mayo elbow performance index, MEPI）和简化的臂肩手功能障碍评估表（the shortened disabilities of the arm, shoulder and hand, Quick-DASH）评价患者的术后功能，同时行满意度调查和X线片随访。结果13例患者均获得随访，随访时间8~41个月，平均20.2个月。肘关节屈伸活动65°~140°，平均112°，前臂旋转活动150°~180°，平均170°。MEPI评分85~100分，平均96分，其中优12例，良1例，优良率为100%。Quick-DASH量表得分0~16.7分，平均6.2分。满意度评价，8例为非常满意，4例为满意，1例为一般。骨折均完全愈合，愈合时间11~24周，平均12.7周；无一例发生内外翻畸形、不稳定、感染、尺神经损伤等并发症。术后5例诉内固定刺激引起轻度不适，其中3例屈伸活动度＜100°，被诊断为关节僵硬（1例取出内固定，1例取内固定同时行内侧副韧带松解，1例拒绝治疗）。结论 Synthes解剖锁定加压钢板螺钉角稳定结合克氏针关节面下支撑治疗关节面粉碎的尺骨鹰嘴粉碎性骨折固定确实，有利于肘关节早期活动，临床应用效果优良。
목적：탐토각은정원칙결합관절면하지탱치료관절면분쇄적척골응취골절적료효。방법회고성분석2008년11월지2012년6월，채용Synthes해부쇄정가압강판결합관절면하극씨침고정치료13례관절면분쇄적척골응취골절환자자료，남7례，녀6례；년령20~77세，평균52세；좌측9례，우측4례。Mayo분형：ⅡB형11례，ⅢB형2례；Schatzker-Schmeling분형：A2형2례，C형9례，D형2례，기중C형골절중1례반Ⅰ형관상돌골절（Regan화Morrey분형）。사용Mayo주관절평분지수（Mayo elbow performance index, MEPI）화간화적비견수공능장애평고표（the shortened disabilities of the arm, shoulder and hand, Quick-DASH）평개환자적술후공능，동시행만의도조사화X선편수방。결과13례환자균획득수방，수방시간8~41개월，평균20.2개월。주관절굴신활동65°~140°，평균112°，전비선전활동150°~180°，평균170°。MEPI평분85~100분，평균96분，기중우12례，량1례，우량솔위100%。Quick-DASH량표득분0~16.7분，평균6.2분。만의도평개，8례위비상만의，4례위만의，1례위일반。골절균완전유합，유합시간11~24주，평균12.7주；무일례발생내외번기형、불은정、감염、척신경손상등병발증。술후5례소내고정자격인기경도불괄，기중3례굴신활동도＜100°，피진단위관절강경（1례취출내고정，1례취내고정동시행내측부인대송해，1례거절치료）。결론 Synthes해부쇄정가압강판라정각은정결합극씨침관절면하지탱치료관절면분쇄적척골응취분쇄성골절고정학실，유리우주관절조기활동，림상응용효과우량。
Objective To evaluate the treatment effects of the olecranon comminuted fracture by the angle stability prin-ciple combined with support under the articular surface. Methods From November 2008 to June 2012, 13 patients (7 male and 6 female, aged from 20 to 77 years) suffered from olecranon comminuted fracture were treated with Synthes anatomy locking com-pression plate and screws combined with Kirschner wires supporting under the articular surface through the posterior median ap-proach. Fractures occurred in the left elbow in 9 and in the right elbow in 4. According to the Mayo classification, 11 cases were classified as Mayo type IIB and 2 as IIIB. According to the Schatzker-Schmeling classification, 2 fractures were type A2, 9 type C, and 2 type D. One patient with type C fracture also had type I coronoid fracture according to Regan and Morrey classification. The Mayo elbow performance index (MEPI) and the shortened disabilities of the arm shoulder and hand (Quick-DASH) were employed to evaluate the functions. All patients took the satisfaction survey and X-ray during the follow-up. Results All patients were fol-lowed-up for 8 to 41 months. The mean ROM of the elbow joint was 112° (range, 65°-140° ), and the mean rotation angle of the forearm was 170° (range, 150°-180°). The mean score for the MEPI was 96 (range, 85-100), excellent 12, good 1. The mean score for the Quick-DASH was 6.2 (range, 0-16.7). In the satisfaction survey, 8 patients were very satisfied, 4 satisfied, 1 common level. All patients took the X-ray during the follow-up and all of them had achieved fracture union completely with the mean time period as 12.7 weeks (range, 11-24 weeks). No cubitus varus, valgus, and instability were found in all patients. No complication, such as infection, ulnar nerve injuries and etc. was found. Five patients complained about mild discomfort caused by internal fixation at 3 months after surgery. Three of them were diagnosed as joint stiffness because of ROM within 100° . One case in 3 elbow stiffness patients developed osteoarthritis after eight months, but no pain during joint activity. Internal fixation was removed in one case;an-other young patient took the operation for removal of internal fixation and release of medial ligament;the third patient refused oper-ation. Conclusion Angle stability principle (Synthes anatomy locking compression plate and screws) combined with supporting under the articular surface (Kirschner wires) can achieve stable fixation in treating olecranon comminuted fracture. It may realize the early exercise of the elbow joint with excellent clinical results. Therefore, it may be an optional choice in clinical practice.