CAJ | 학술논문

目的探讨应用袢钢板治疗Regan-Morry Ⅰ型冠状突骨折的技术特点及疗效. 方法回顾性分析2011年1月至2014年3月采用袢钢板技术治疗的42例Regan-Morry Ⅰ型冠状突骨折患者资料,男31例,女11例;年龄23 ～ 58岁,平均39.3岁;其中单纯冠状突骨折4例,冠状突骨折伴肘关节脱位患者5例,肘部损伤“三联征”33例,冠状突为粉碎性骨折30例,简单骨折12例.所有患者均采用Kocher入路,附加后侧小切口.12例简单骨折患者均获得解剖复位并使用袢钢板固定,30例粉碎性骨折患者均使用袢钢板重建前方关节囊及肱肌止点,对合并桡骨小头骨折的38例患者行桡骨小头置换,对合并外侧副韧带损伤者进行锚钉修复.记录骨折复位、袢钢板固定后是否有骨折复位丢失,骨折愈合时间和并发症情况.末次随访时采用Mayo肘关节功能评分(MEPS)评定肘关节功能. 结果 38例患者术后获8 ～ 34个月(平均25个月)随访,4例失访.所有患者骨折均获骨性愈合,愈合时间为6～18周,平均11.8周.末次随访时肘部屈曲活动度110°～ 135°,平均115°;肘部伸直活动度0～15°,平均5°;前臂旋前45°～ 75°,平均70°;旋后68°～94°,平均82°.根据MEPS评分评定疗效:优22例,良10例,可2例,差4例,优良率为84.2％.所有患者均无伤口深部感染,1例患者出现桡骨小头钢板断裂,4例患者出现肘关节僵硬.1例患者出现伤口浅部感染经抗感染、换药治疗后愈合. 结论应用袢钢板治疗Regan-Morry Ⅰ型冠状突骨折,可在直视下复位,固定牢靠,有利于关节稳定性恢复,冠状突骨折愈合,操作简单,效果良好.
목적 탐토응용번강판치료Regan-Morry Ⅰ형관상돌골절적기술특점급료효. 방법 회고성분석2011년1월지2014년3월채용번강판기술치료적42례Regan-Morry Ⅰ형관상돌골절환자자료,남31례,녀11례;년령23 ～ 58세,평균39.3세;기중단순관상돌골절4례,관상돌골절반주관절탈위환자5례,주부손상“삼련정”33례,관상돌위분쇄성골절30례,간단골절12례.소유환자균채용Kocher입로,부가후측소절구.12례간단골절환자균획득해부복위병사용번강판고정,30례분쇄성골절환자균사용번강판중건전방관절낭급굉기지점,대합병뇨골소두골절적38례환자행뇨골소두치환,대합병외측부인대손상자진행묘정수복.기록골절복위、번강판고정후시부유골절복위주실,골절유합시간화병발증정황.말차수방시채용Mayo주관절공능평분(MEPS)평정주관절공능. 결과 38례환자술후획8 ～ 34개월(평균25개월)수방,4례실방.소유환자골절균획골성유합,유합시간위6～18주,평균11.8주.말차수방시주부굴곡활동도110°～ 135°,평균115°;주부신직활동도0～15°,평균5°;전비선전45°～ 75°,평균70°;선후68°～94°,평균82°.근거MEPS평분평정료효:우22례,량10례,가2례,차4례,우량솔위84.2％.소유환자균무상구심부감염,1례환자출현뇨골소두강판단렬,4례환자출현주관절강경.1례환자출현상구천부감염경항감염、환약치료후유합. 결론 응용번강판치료Regan-Morry Ⅰ형관상돌골절,가재직시하복위,고정뢰고,유리우관절은정성회복,관상돌골절유합,조작간단,효과량호.
Objective To explore the clinical efficacy of loop plating for treatment of ulnar coronoid fractures of Regan-Morry type Ⅰ.Methods From January 2011 to March 2014,42 patients with ulnar coronoid fracture of Regan-Morry type Ⅰ were treated in our department.They were 31 males and 11 females,23 to 58 years of age (mean,39.3 years).There were 5 cases of coronoid fracture combined with elbow dislocation,33 cases of terrible triad injury,30 cases of comminuted coronoid process,and 12 cases of simple fractures.All the patients were treated through the Kocher approach aided by a small posterior incision.The 12 simple fractures were fixated with a loop plate after anatomic reduction.The anterior joint capsule and the brachialis muscle insertion were reconstructed with a loop plate in the 30 cases of comminuted fractures.Replacement of the radial head was performed in the 38 cases of combined radial head fracture.Anchor repair was conducted for cases combined with disruption of lateral collateral ligament.Reduction,reduction loss after loop plating,fracture healing time and complications were documented.The elbow function was evaluated at the last follow-up by Mayo elbow performance score (MEPS).Results Thirty-eight patients were followed up for 8 to 34 months (average,25 months),and 4 patients were lost.All the 38 patients obtained bony union after 6 to 18 weeks (average,11.8 weeks).At the last follow-up,elbow flexion ranged from 110° to 135° (average,115°),elbow extension from 0 to 15° (average,5°),forearm pronation from 45° to 75° (average,70°),and supination from 68° to 94° (average,82°).According to MEPS,22 patients were excellent,10 good,2 fair,and 4 poor.The excellent to good rate was 84.2％.None of the patients had deep wound infection.Plate breakage at the radial head occurred in one case and stiff elbow in 4.One case had superficial wound infection which responded to dressing changes.Conclusions In treatment of ulnar coronoid fractures of Regan-Morry type Ⅰ,loop plating can result in good efficacy because it allows reduction under direct vision,leads to rigid fixation which facilitates articular stability,and is simple as well.