CAJ | 학술논문

目的探讨子母螺钉固定治疗Regan-MorreyⅡ型尺骨冠突骨折的初期临床疗效.方法回顾性分析2010年10月至2012年6月,采用子母螺钉固定治疗12例Regan-MorreyⅡ型尺骨冠突骨折患者资料,男8例,女4例；年龄19～69岁,平均42.3岁.其中9例合并桡骨头骨折,2例合并尺骨近端骨折,1例合并尺神经损伤,8例合并韧带损伤,7例合并肘关节脱位；7例诊断为肘关节恐怖三联征.先治疗桡骨头骨折,然后采用1枚子母螺钉固定治疗冠突骨折,最后复位肘关节及修复韧带损伤.采用Mayo肘关节功能评分(Mayo elbow performance score,MEPS)评估临床功能,以Broberg-Morrey影像学标准对骨关节炎进行分级.结果 12例患者均获得5～18个月随访,肘关节屈伸活动度平均为121.8°,旋转活动度为平均145.1°.MEPS评分为72～100分；优4例,良7例,可1例,优良率91.7％.术后2例(16.7％)有骨关节炎征象,其中Broberg-Morrey分级1级1例,2级1例.末次随访时1例发生轻度异位骨化.肘关节均得到解剖复位；骨折均愈合,愈合时间1.8～3.4个月.1例尺神经损伤患者术后3个月完全恢复.术后无一例发生继发性关节脱位、内固定松动、移位或断裂、感染及行二次手术.结论采用切开复位子母螺钉固定治疗Regan-MorreyⅡ型尺骨冠突骨折,术后肘关节功能恢复良好,并发症少.
목적 탐토자모라정고정치료Regan-MorreyⅡ형척골관돌골절적초기림상료효.방법 회고성분석2010년10월지2012년6월,채용자모라정고정치료12례Regan-MorreyⅡ형척골관돌골절환자자료,남8례,녀4례；년령19～69세,평균42.3세.기중9례합병뇨골두골절,2례합병척골근단골절,1례합병척신경손상,8례합병인대손상,7례합병주관절탈위；7례진단위주관절공포삼련정.선치료뇨골두골절,연후채용1매자모라정고정치료관돌골절,최후복위주관절급수복인대손상.채용Mayo주관절공능평분(Mayo elbow performance score,MEPS)평고림상공능,이Broberg-Morrey영상학표준대골관절염진행분급.결과 12례환자균획득5～18개월수방,주관절굴신활동도평균위121.8°,선전활동도위평균145.1°.MEPS평분위72～100분；우4례,량7례,가1례,우량솔91.7％.술후2례(16.7％)유골관절염정상,기중Broberg-Morrey분급1급1례,2급1례.말차수방시1례발생경도이위골화.주관절균득도해부복위；골절균유합,유합시간1.8～3.4개월.1례척신경손상환자술후3개월완전회복.술후무일례발생계발성관절탈위、내고정송동、이위혹단렬、감염급행이차수술.결론 채용절개복위자모라정고정치료Regan-MorreyⅡ형척골관돌골절,술후주관절공능회복량호,병발증소.
Objective To evaluate the preliminary clinical effect of child-mother screw for fixation of Regan-Morrey type Ⅱ coronoid process fracture.Methods Data of 12 patients who had undergone open reduction and internal fixation with child-mother screw for Regan-Morrey type Ⅱ coronoid process fracture from October 2010 to June 2012 were retrospectively analyzed,including 8 males and 4 females,aged from 19 to 69 years (average,42.3 years).Ten patients had associated injuries,including radial head fracture in 9 patients,proximal ulnar fracture in 2 patients,ligament injury in 8 patients,ulnar never injury in 1 patient and elbow dislocation in 7 patients.The so-called terrible triad injury was found in 7 patients.The Mayo Elbow Performance Score (MEPS) and the Broberg-Morrey criteria were used to assess clinical outcome and signs of arthritis,respectively.Results All the patients were followed up for 5 to 18 months.The flexionextension arc of the elbow averaged 121.8°,and forearm rotation averaged 145.1°.The MEPS ranged from 72 to 100 points,the result was excellent in 4 patients,good in 7,and fair in 1,and the excellent and good rate was 91.7％.According to the Broberg-Morrey criteria,2 patients (16.7％) showed signs of posttraumatic arthritis,including 1 case of grade 1 and 1 case of grade 2.At the final follow-up,mild heterotopic ossification occurred in 1 patient.All fractures achieved bone union,and the healing time ranged from 1.8 to 3.4 months.Ulnar nerve function returned to normal in 1 patient with ulnar nerve injury 3 months after operation.All patients achieved concentric reduction.No infection,secondary dislocation of joint,loosening or breakage of the implant occurred,and no patient required reoperation.Conclusion Open reduction and internal fixation with child-mother screws for Regan-Morrey type Ⅱ coronoid process fracture can restore sufficient elbow stability,enhance the functional outcome and reduce complications.