切换至 "中华医学电子期刊资源库"

中华老年骨科与康复电子杂志 ›› 2020, Vol. 06 ›› Issue (06) : 334 -339. doi: 10.3877/cma.j.issn.2096-0263.2020.06.004

所属专题: 文献

骨与创伤

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
丰瑞兵1, 王华松2, 庞炯宇2, 姜壮2, 蔡贤华1,()   
  1. 1. 430060 武汉,湖北中医药大学针灸骨伤学院
    2. 430070 武汉,中部战区总医院骨科
  • 收稿日期:2020-04-12 出版日期:2020-12-05
  • 通信作者: 蔡贤华
  • 基金资助:
    湖北省卫计委医药科研项目(WJ2018H0069)

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

Ruibing Feng1, Huasong Wang2, Jiongyu Pang2, Zhuang Jiang2, Xianhua Cai1()   

  1. 1. College of Acupuncture and Bone Injury, Hubei University of Traditional Chinese Medicine, Wuhan 430060, China
    2. Department of Orthopedics, General Hospital of Central Theater Command, Wuhan 430060, China
  • Received:2020-04-12 Published:2020-12-05
  • Corresponding author: Xianhua Cai
引用本文:

丰瑞兵, 王华松, 庞炯宇, 姜壮, 蔡贤华. 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[J/OL]. 中华老年骨科与康复电子杂志, 2020, 06(06): 334-339.

Ruibing Feng, Huasong Wang, Jiongyu Pang, Zhuang Jiang, Xianhua Cai. Treatment of ulna-olecranon fractures with articular surface collapse with a locking plate plus Lost K-wire technique[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2020, 06(06): 334-339.

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。

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.

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
1
Koziarz A, Woolnough T, Oitment C, et al. Surgical management for olecranon fractures in adults: a systematic review and meta-analysis [J]. Orthopedics, 2019, 42(2): 75-82.
2
Jean-François B, Corbeau S, Decambron A, et al. Stabilization of olecranon fractures by tension band wiring or plate osteosynthesis: a retrospective study of 41 cases [J]. Vet Comp Orthop Traumatol, 2018, 31(1): 053-061.
3
Anthony FG, Paul T, Sinicrope BJ, et al. Outcomes after plating of olecranon fractures: A multicenter evaluation [J]. Injury, 2016, 47(7): 1466-1471.
4
Navarro RA, Hsu A, Jun W, et al. Complications in olecranon fracture surgery: a comparison of tension band vs. locked plate osteosynthesis [J]. J Shoulder Elbow Surg, 2013, 22(10): e34.
5
Broberg M, Morrey BF. Results of treatment of fracture dislocation of the elbow [J]. Clin Orthop Relat Res, 1987 (216): 109-119.
6
Powell AJ, Farhan-Alanie OM, Bryceland JK, et al. The treatment of olecranon fractures in adults [J]. Musculoskelet Surg, 2017, 101(1): 1-9.
7
Seong CP, Hyun SG, Kahyun K, et al. Olecranon fractures have features of osteoporotic fracture [J]. J Bone Metab, 2017, 24(3): 175.
8
Lubberts B, Mellema JJ, Janssen SJ, et al. Fracture line distribution of olecranon fractures [J]. Arch Orthop Trauma Surg, 2017, 137(1): 37-42.
9
Colton CL. Fractures of the olecranon in adults: classification and management [J]. Injury, 1973, 5(2): 121-129.
10
Sehatzker J. Fractures of the olecranon [M]//Schatzker J, Tile M. The rationale of operative fracture care.3rd ed. New York: Springer Berlin Heidelberg, 2005: 124-126.
11
Duckworth AD, Clement ND, White TO, et al. Plate versus Tension-Band wire fixation for olecranon fractures:a prospective randomized trial [J]. J Bone Joint Surg Am, 2017, 99(15): 1261.
12
殷渠东,顾三军,刘军,等.尖齿开口钩钢板治疗尺骨鹰嘴骨折疗效观察[J].中国修复重建外科杂志,2016,30(9): 1094-1097.
13
李春江.改良张力带技术治疗尺骨鹰嘴骨折[J].中国修复重建外科杂志,2016,30(3): 392-393.
14
Fantry A, Sobel A, Capito N, et al. Biomechanical assessment of locking plate fixation of comminuted proximal olecranon fractures [J]. J Orthop Trauma, 2018, 32(11): e445-e450.
15
Geßmann J, Königshausen M, Schildhauer TA, et al. Chronic bony instability of the elbow joint [J]. Orthop, 2016, 45(10): 822-831.
16
Tarassoli P, Mccann P, Amirfeyz R. Complex instability of the elbow [J]. Injury, 2017, 48(3): 568-577.
17
De Giacomo A F, Tornetta P, Sinicrope B J, et al. Outcomes after plating of olecranon fractures: A multicenter evaluation [J]. Injury,2016,47(7):1466-1471.
18
王世龙,汤超亮,张权,等.角稳定钢板结合关节面下支撑治疗关节面粉碎的尺骨鹰嘴骨折[J].中华骨科杂志,2014,34(10): 1008-1015.
19
Dorr MC, Backes M, Luitse JS, et al. Complications of kirschner wire use in open reduction and internal fixation of calcaneal fractures [J]. J Foot Ankle Surg, 2016, 55(5): 915-917.
20
赵旭辉,张德清,应有荣,等.多枚大头钉式克氏针固定治疗Mason Ⅲ型桡骨小头骨折19例疗效观察[J].中医正骨,2007,19(4): 19-20.
[1] 高秋芳, 张万锋, 盛泉音, 马彬. 足底内侧皮瓣联合腓动脉穿支皮瓣修复足跟部巨大恶性黑色素瘤切除后创面的临床效果[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 491-497.
[2] 齐伟亚, 方杰, 左志诚, 刘桂谦, 裴广楠, 刘波. 内窥镜辅助下改良Okutsu 法治疗腕管综合征的临床疗效[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 503-506.
[3] 唐金侨, 叶宇佳, 王港, 赵彬, 马艳宁. 医学影像学检查方法在颞下颌关节紊乱病中临床应用研究进展[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(06): 406-411.
[4] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[5] 李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.
[6] 杨建波, 马欢, 黄小梅, 刘华柱. 结肠镜辅助下EMR、CSP和RFA术治疗直径<1cm结直肠息肉的疗效和安全性比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 76-79.
[7] 冯旺, 马振中, 汤林花. CT扫描三维重建在肝内胆管细胞癌腹腔镜肝切除术中的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 104-107.
[8] 江志鹏, 钟克力, 陈双. 复杂腹壁疝手术后腹腔高压与腹腔间室综合征的预防和处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 612-615.
[9] 朱佳琳, 方向, 贵诗雨, 黄丹, 周小雨, 郭文恺. 大鼠切口疝腹膜前间隙补片修补术后血清中VEGF 和Ang-1 的表达情况[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 703-707.
[10] 马振威, 宋润夫, 王兵. ERCP胆道内支架与骑跨十二指肠乳头支架置入治疗不可切除肝门部胆管癌疗效的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 807-812.
[11] 李新宇, 梁建锋. 3D打印导板辅助颅内血肿穿刺引流手术[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(06): 382-384.
[12] 刘琦, 王守凯, 王帅, 苏雨晴, 马壮, 陈海军, 司丕蕾. 乳腺癌肿瘤内微生物组的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 841-845.
[13] 于洁, 金小红, 顾艳楣, 王慧, 葛杨杨, 李燕. 癌症相关静脉血栓栓塞症患者疾病体验与需求的质性研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 739-744.
[14] 喻蓉, 周伟力, 雷青, 陈松, 陈立, 刘峰, 丁州, 阳宏奇, 王康, 王大鹏. 改良的内外侧环抱锁定钢板在复杂胫骨平台骨折治疗中的临床疗效观察[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 764-770.
[15] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?