锁定钢板加克氏针埋头技术（Lost K-wire）治疗伴关节面塌陷的尺骨鹰嘴骨折的临床研究

doi:10.3877/cma.j.issn.2096-0263.2020.06.004

目的

探讨锁定钢板加克氏针埋头技术（Lost K-wire）治疗伴关节面塌陷的尺骨鹰嘴骨折的临床疗效。

方法

回顾性分析2016年6月至2019年01月中国人民解放军中部战区总医院收治的采用锁定钢板加Lost K-wire技术治疗的18例伴关节面塌陷的尺骨鹰嘴骨折患者的临床资料，其中男性12例，女性6例；年龄22~62岁，平均（35±8）岁；运动伤6例，交通伤8例，摔伤3例，坠落伤1例。根据患者末次随访的肘关节活动范围和肘关节Broberg&Morrey评分标准对患者进行疗效评价。

结果

18例患者均获至少6个月，平均（10±5）个月的随访，所有患者手术切口均Ⅰ期愈合，未见伤口感染，神经血管损伤、肘关节僵硬等并发症，无患者发生骨折复位丢失，所有患者骨折均骨性愈合，愈合时间12~24 w，平均（17±4）w。末次随访肘关节屈伸活动范围90°~150°，平均（118±22）°，前臂旋转活动范围150°~180°，平均（160±11）°。末次随访肘关节Broberg&Morrey评分75~100分，平均（93±6）分，优13例，良4例，可1例，优良率94.44%。

结论

锁定钢板加Lost K-wire技术治疗伴关节面塌陷的尺骨鹰嘴骨折能有效复位并维持塌陷关节面的平整及稳定性，有利于患者早期功能锻炼，术后疗效确切，是该类型骨折一种可靠的治疗选择。

关键词: 接骨板, 骨针, 骨折固定术, 内, 尺骨骨折

Objective

To evaluate the clinical effect of the locking plate plus Lost K-wire technique in the treatment of olecranon fractures with joint surface collapse.

Methods

The clinical data of 18 cases of ulna olecranon fracture with joint surface collapse in our hospital from June 2016 to January 2019 were retrospectively analyzed, including 12 males and 6 females; aged from 22 to 62 years, with an average of (35±8) years, 6 cases of sports injuries. 8 cases of traffic injury, 3 cases of injury and 1 case of falling injury. The patient was evaluated for efficacy based on the elbow joint activity range and the elbow joint Broberg&Morrey score criteria for the patient's last follow-up.

Results

All the 18 patients were followed up for at least 6 months. All the patients healed in one stage. No complications such as wound infection, neurovascular injury, elbow stiffness and so on were found. No fracture reduction loss occurred in all patients. The fracture healing time was 12-24 weeks, with an average of 17±4 weeks. The range of flexion and extension of elbow joint was 90 °-150 °, the average was (118±22) °, and the range of rotation of forearm was 150 °-180 °, with an average of (160±11)°. The Broberg&Morrey score of elbow joint was 75-100 points, with an average of (93±6) points, excellent in 13 cases, good in 4 cases and fair in 1 case. The excellent and good rate was 94.44%.

Conclusion

Locking plate plus Lost K-wire technique can effectively reduce and maintain the smoothness and stability of the collapsed joint surface, which is beneficial to the early functional exercise of the patients. The postoperative curative effect is accurate, and it is a reliable choice for the treatment of this type of fracture.

Key words: Bone plates, Bone wires, Fracture fixation, internal, Ulna fractures

图1~12 男性，22岁，运动伤致右肘关节肿痛7 h入院，伤后5 d行锁定钢板加Lost K-wire技术治疗。图1~3患者术前肘关节正侧位X线片及CT三维重建图像，可见右尺骨鹰嘴斜型骨折伴关节面塌陷（蓝色剪头所示），属于Colton ⅡC型尺骨鹰嘴骨折；图4~6分别为患者术后2 d肘关节CT三维重建及右肘关节正侧位X线片，可见术后尺骨鹰嘴骨折复位良好，关节面平整，克氏针（埋头的克氏针见图中红色箭头所指）、螺钉、钢板位置、长度满意；图7~8术后1年右肘关节正侧位X线片，可见骨折已愈合；图9~12术后6个月肘关节功能情况，患者功能恢复良好，Broberg&Morrey肘关节评分为97分

图13~24 女性，26岁，车祸伤致左肘关节肿痛1 d入院，伤后3 d行左尺骨鹰嘴骨折切开复位内固定治疗。图13~14术前左肘关节CT三维重建图像，左尺骨鹰嘴横断骨折伴图关节面塌陷（蓝色剪头所示），属于SchatzkerB型尺骨鹰嘴骨折；图15~17术后2 d左肘关节正侧位X线片及肘关节CT三维重建图像，可见术后尺骨鹰嘴骨折复位良好，关节面平整，克氏针（埋头的克氏针见图中红色箭头所指）、螺钉、钢板位置、长度满意；图18术后1年左肘关节侧位X线图像，患者骨折愈合良好；图19~20术后1年钢板取出术后左肘关节X线图片，钢板、螺钉已取出，埋头的克氏针存留；图21~24患者术后1年左肘关节功能情况，功能恢复良好，Broberg&Morrey肘关节评分为96分

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Treatment of ulna-olecranon fractures with articular surface collapse with a locking plate plus Lost K-wire technique

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Treatment of ulna-olecranon fractures with articular surface collapse with a locking plate plus Lost K-wire technique