雪橇板技术治疗尺骨鹰嘴骨折的临床观察
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摘要
目的:探讨鹰嘴雪橇板固定技术治疗尺骨鹰嘴骨折的临床疗效。方法:2017年3月采用鹰嘴雪橇板固定技术治疗4例尺骨鹰嘴骨折患者,其中男2例,女2例;年龄40,46,47,72岁;左侧3例,右侧1例;均为摔伤引起。骨折均为横行、斜行或轻度关节面压缩骨折。伤后1～3 d内进行手术。观察患者的手术时间、术中出血量、并发症及术后肘关节屈伸和前臂功能恢复情况,采用VAS评分评价疼痛缓解程度,并采用Mayo肘关节功能评分评价肘关节功能恢复情况。结果:至2018年9月,4例获得随访,时间18个月。手术时间40～60 min,术中出血量20～40 ml,术后无切口并发症。所有患者术后4个月随访时骨折愈合。末次随访时屈肘140°～150°,伸肘0°～过伸10°,屈伸活动范围140°～160°,MEPS评分为100分。患者活动时无明显疼痛感,VAS评分为0分。结论:鹰嘴雪橇板的低切迹设计和一体化设计避免了张力带和钢板常见的内固定物激惹现象,操作简单,对于简单和轻度粉碎的鹰嘴骨折是一种理想的内固定方式,但不适用于严重粉碎的鹰嘴骨折。
Objective:To explore clinical effect of olecranon sled in treating olecranal fracture. Methods:Four patients with olecranal fracture treated by olecranon sled in March 2017,including 2 males and 2 females,age of 40,46,47,72 years old,3 patients on the left side and 1 patient on the right side. All patients were caused by falling down. Fracture were transverse,oblique and slightly compressive articular surface fracture. The time from injury to operation ranged from 1 to 3 days.Operative time,blood loss,complications and flexion and extension of elbow joint,and function of forearm were observed,VAS score was used to evaluate relieve degree of pain,and Mayo score was applied to assess recovery of elbow function. Results:Four patients were followed up until September 2018. Operative time ranged from 40 to 60 min,blood loss was for 20 to 40 ml,and no complications occurred. All fracture were healed at 4 months after operation. Elbow flexion was for 140 ° to 150°,extension of elbow was from 0° and extend to 10°,activity of flexion and extension ranged from 140 ° to 160°,MEPS score was 100.No pain occurred during doing activity,and VAS score was 0. Conclusion:Low-profile design and integrated design of olecranon sled could avoid irritation of tension band and plate,and it is a simple and ideal internal fixation method for simple and mildly comminuted olecranon fracture,which is not suitable for severely comminuted olecranon fracture.
Objective:To explore clinical effect of olecranon sled in treating olecranal fracture. Methods:Four patients with olecranal fracture treated by olecranon sled in March 2017,including 2 males and 2 females,age of 40,46,47,72 years old,3 patients on the left side and 1 patient on the right side. All patients were caused by falling down. Fracture were transverse,oblique and slightly compressive articular surface fracture. The time from injury to operation ranged from 1 to 3 days.Operative time,blood loss,complications and flexion and extension of elbow joint,and function of forearm were observed,VAS score was used to evaluate relieve degree of pain,and Mayo score was applied to assess recovery of elbow function. Results:Four patients were followed up until September 2018. Operative time ranged from 40 to 60 min,blood loss was for 20 to 40 ml,and no complications occurred. All fracture were healed at 4 months after operation. Elbow flexion was for 140 ° to 150°,extension of elbow was from 0° and extend to 10°,activity of flexion and extension ranged from 140 ° to 160°,MEPS score was 100.No pain occurred during doing activity,and VAS score was 0. Conclusion:Low-profile design and integrated design of olecranon sled could avoid irritation of tension band and plate,and it is a simple and ideal internal fixation method for simple and mildly comminuted olecranon fracture,which is not suitable for severely comminuted olecranon fracture.
引文
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[5]Morrey BF,Adams RA.Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow[J].J Bone Joint Surg Am,1992,74(4):479-490.
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[7]Petraco DM1,Koval KJ,Kummer FJ,et al.Fixation stability of olecranon osteotomies[J].Clin Orthop Relat Res,1996,(333):181-185.
[8]Mullett JH,Shannon F,Noel J,et al.K wire position in tension band wiring of the olecranon a comparison of two techniques[J].Injury,2000,31(6):427-431.
[9]Wu CC,Tai CL,Shih CH.Biomechanical comparison for different configurations of tension band wiring techniques in treating an olecranon fracture[J].J Trauma,2000,48(6):1063-1067.
[10]Parker JR,Conroy J,Campbell DA.Anterior interosseous nerve injury following tension band wiring of the olecranon[J].Injury,2005,36:1252-1253.
[11]Prayson MJ,Iossi MF,Buchalter D,et al.Safe zone for anterior cortical perforation of the ulna during tension band wire fixation:a magnetic resonance imaging analysis[J].J Shoulder Elbow Surg,2008,17(1):121-125.
[12]董晓敏,杨杰,王朝南,等.新型带孔克氏针张力带治疗成人尺骨鹰嘴骨折的病例对照研究[J].中国骨伤,2018,31(6):534-537.DONG XM,YANG J,WANG CN,et al.Case control study on a new Kirschner wire tension band with hole in the treatment of adult olecranon fractures in adults[J].Zhongguo Gu Shang/China J Orthop Trauma,2018,31(6):534-537.Chinese with abstract in English.
[13]Hak DJ,Golladay GJ.Olecranon fractures:treatment options[J].JAm Acad Orthop Surg,2000,8(4):266-275.
[14]Ali M,Hatzantonis C,Aspros D,et al.Management of typeⅡB andⅢB olecranon fractures.Case series[J].Int J Surg Case Rep,2017,41:296-300.
[15]Bailey CS,Mac Dermid J,Patterson SD,et al.Outcome of plate fixation of olecranon fractures[J].J Orthop Trauma,2001,15(8):542-548.
[16]Dieterich J,Kummer FJ,Ceder L.The olecranon sled a new device for fixation of fractures of the olecranon:a mechanicalcomparison of two fixation methods in cadaver elbows[J].Acta Orthop,2006,77(3):440-444.
[2]Carter TH,Molyneux SG,Reid JT,et al.Tension band wire fixation of olecranon fractures[J].JBJS Essent Surg Tech,2018,8(3):e22.
[3]Adams JE,Sems SA,Steinmann SP.Open treatment of olecranon fractures with plate fixation[J].JBJS Essent Surg Tech,2018,8(1):e1.
[4]Newman SD,Mauffrey C,Krikler S.Olecranon fractures[J].Injury,2009,40(6):575-581.
[5]Morrey BF,Adams RA.Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow[J].J Bone Joint Surg Am,1992,74(4):479-490.
[6]严广斌.视觉模拟评分法[J].中华关节外科杂志,2014,8(2):34.YAN GB.Visual analogue scale[J].Zhonghua Guan Jie Wai Ke Za Zhi,2014,8(2):34.Chinese.
[7]Petraco DM1,Koval KJ,Kummer FJ,et al.Fixation stability of olecranon osteotomies[J].Clin Orthop Relat Res,1996,(333):181-185.
[8]Mullett JH,Shannon F,Noel J,et al.K wire position in tension band wiring of the olecranon a comparison of two techniques[J].Injury,2000,31(6):427-431.
[9]Wu CC,Tai CL,Shih CH.Biomechanical comparison for different configurations of tension band wiring techniques in treating an olecranon fracture[J].J Trauma,2000,48(6):1063-1067.
[10]Parker JR,Conroy J,Campbell DA.Anterior interosseous nerve injury following tension band wiring of the olecranon[J].Injury,2005,36:1252-1253.
[11]Prayson MJ,Iossi MF,Buchalter D,et al.Safe zone for anterior cortical perforation of the ulna during tension band wire fixation:a magnetic resonance imaging analysis[J].J Shoulder Elbow Surg,2008,17(1):121-125.
[12]董晓敏,杨杰,王朝南,等.新型带孔克氏针张力带治疗成人尺骨鹰嘴骨折的病例对照研究[J].中国骨伤,2018,31(6):534-537.DONG XM,YANG J,WANG CN,et al.Case control study on a new Kirschner wire tension band with hole in the treatment of adult olecranon fractures in adults[J].Zhongguo Gu Shang/China J Orthop Trauma,2018,31(6):534-537.Chinese with abstract in English.
[13]Hak DJ,Golladay GJ.Olecranon fractures:treatment options[J].JAm Acad Orthop Surg,2000,8(4):266-275.
[14]Ali M,Hatzantonis C,Aspros D,et al.Management of typeⅡB andⅢB olecranon fractures.Case series[J].Int J Surg Case Rep,2017,41:296-300.
[15]Bailey CS,Mac Dermid J,Patterson SD,et al.Outcome of plate fixation of olecranon fractures[J].J Orthop Trauma,2001,15(8):542-548.
[16]Dieterich J,Kummer FJ,Ceder L.The olecranon sled a new device for fixation of fractures of the olecranon:a mechanicalcomparison of two fixation methods in cadaver elbows[J].Acta Orthop,2006,77(3):440-444.