尺桡骨近端粉碎骨折伴肘关节后脱位治疗

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1、尺桡骨近端粉碎骨折伴肘关节后脱位治疗【摘要】目的探讨尺桡骨近端粉碎骨折伴肘关节后脱位的治疗方法和疗效。方法尺桡骨近端粉碎骨折伴肘关节后脱位患者30例,男23例,女7例;年龄18~52岁,平均年龄30岁。采用钢板螺钉内固定治疗,其中一期植骨20例。桡骨小头骨折部分,如骨折粉碎不严重,复位后用克氏针固定,并修补环状韧带;如骨折粉碎严重,则行人工桡骨头置换,同时取自体掌长肌腱重建环状韧带。尺骨冠突骨折部分,选用克氏针或拉力螺钉固定骨折块,同时探查尺侧副韧带前束,如损伤予以修复或重建;如合并尺骨鹰嘴骨折,采用钢板螺钉内固定治疗。结果患者伤口均一期愈合,骨折愈合率为100

2、%。术后随访10~48个月,平均29个月。5例有创伤性关节炎表现,2例发生轻度创伤性骨化。肘关节平均屈伸范围100°~110°,前臂平均旋转活动范围为90°~100°。按照Morrey等肘关节功能评分标准进行评价:优12例,良15例,可2例,差1例,总优良率为90%。结论治疗尺桡骨近端粉碎骨折伴肘关节后脱位可采用钢板螺钉固定尺桡骨近端骨折,必要时行一期植骨,注意对桡骨,尺骨冠突骨折及肘关节侧副韧带损伤的治疗,以防止肘关节不稳定。【关键词】尺骨近端骨折;桡骨头骨折;肘关节后脱位;骨折内固定9Treatmentinthecomminutefractureofprox

3、imalulnaandradialassociatedwiththeelbowposteriordislocationLiQiang,ZhouZhi-Gang,YanZhao-Hua,etal.Departmentoforthopaedics,TheFirstpeople’shospitalofjiujiang,JiangXi332000,China【Abstract】ObjectiveToinvestigatethesurgicalmanagementoftheproximalulnaandradialcomminutedfracturesassociated

4、withtheelbowposteriordislocationandevaluatetheclinicaloutcome.MethodsFromJanuary2000toOctober2007,30patientswithproximalulnaandradialcomminutedfracturedsassociatedwiththeelbowposteriordislocationweretreated,whichinvolced23malesang7femaleswithanaverageageof30years.Allpatientsweretreat

5、edwiththeplateandscrewfixation.Bonegrafthadbeendonein20patientsduringtheprimaryprocedure.Forradialheadfractured,theinternalfixationwasperformedorradialheadreplacement.Fortheulnacoronoidprocessfractures,internalfixationwereperformedandrepairedtheanteriorbundleoftheulnar9collateralliga

6、ments.ResultsThemeantimeofthefollow-upwas29months.Theunionratewas100%.Noinflammation,neuralinjuriesandelbowinstabilityoccurred.Traumaticosteoarthritisoccurred5cases,andmildheterotopicossificationoccurredin2cases.Themeanrangeofmotionoftheafectedelbowjointwas100°~110°,andtheROMofforear

7、mrotationwas90°~100°.AccordingtoMorrey’sevaluationmethod,12patientswasclassifiedinexcellent,15ingood,2infairand1inpoor.Theexcellentagoodratewas90%.ConclusionElbowstabilitymustberestoredbyaddressingthespecificcompinentsintheinjury.Theproximalulnamustbeanatomicallyreducedandinternallyf

8、ixed;theradi