摘要
目的比较支撑钢板与空心螺钉内固定治疗肘关节Regan-MorreyⅡ型尺骨冠状突骨折的临床疗效。方法采用回顾性病例对照研究分析2015年4月至2018年1月苏州大学附属无锡市第九人民医院收治的53例肘关节Regan-MorreyⅡ型尺骨冠状突骨折患者临床资料,其中男36例,女17例;年龄21~63岁[(36.3±7.1)岁]。24例采用支撑钢板内固定(钢板组),29例采用空心螺钉内固定(螺钉组)。比较两组手术时间及骨折愈合时间。术后1,3,6个月及末次随访时采用视觉模拟评分(VAS)、肘关节屈伸活动度、前臂旋转活动度和Mayo肘关节功能评分(MEPS)对疼痛程度、关节活动度和功能恢复进行评估。观察并发症发生情况。结果患者均获随访15~18个月[(15.9±1.3)个月]。钢板组手术时间为(150.6±24.2)min,长于螺钉组的(126.8±18.3)min(P<0.05)。两组骨折愈合时间和VAS差异无统计学意义(P>0.05)。术后1,3,6个月及末次随访时钢板组肘关节屈伸活动度分别为(87.2±5.8)°、(109.2±7.1)°、(121.3±6.2)°、(127.3±5.4)°,均高于螺钉组的(70.5±9.1)°、(90.2±4.5)°、(108.3±5.1)°、(116.2±4.6)°(P<0.05);钢板组前臂旋转活动度分别为(78.3±9.1)°、(98.7±8.6)°、(130.2±7.1)°、(139.2±6.7)°,均高于螺钉组的(60.1±5.1)°、(80.6±8.7)°、(116.1±5.5)°、(127.3±4.1)°(P<0.05);钢板组MEPS分别为(30.6±7.6)分、(68.6±6.1)分、(90.2±4.3)分、(95.2±2.1)分,均高于螺钉组的(27.2±8.1)分、(54.1±7.1)分、(82.1±5.3)分、(88.2±5.2)分(P<0.05)。钢板组1例术后1周发生切口浅表性感染,经清创和抗生素治疗后愈合;2例发生轻度异位骨化,未特殊处理。螺钉组3例早期活动时螺钉松动、骨折再移位,通过减轻肘关节功能锻炼强度、延长支具保护时间,骨折愈合;4例发生异位骨化,其中1例伴肘关节僵硬,于术后12个月行肘关节松解术,术后肘关节活动度明显提高。钢板组并发症发生率为13%(3/24),低于螺钉组的26%(7/29)
Objective To compare the clinical effect of buttress plate fixation and cannulated screw fixation of Regan-Morrey type II ulnar coronoid fractures.Methods A retrospective case control study was made on 53 patients with Regan-Morrey type II ulnar coronoid fractures admitted to Wuxi No.9 People's Hospital from April 2015 to January 2018,including 36 males and 17 females,aged from 21 to 63 years[(36.3±7.1)years].Among them,24 patients were treated using buttress plates(plate group),and 29 patients using cannulated screws(screw group).The operation time and fracture healing time were documented.The visual analogue score(VAS),range of motion of elbow flexion and extension and forearm rotation and Mayo elbow performance score(MEPS)were assessed at postoperative 1,3,6 months and at the last follow-up.The incidence of complications was observed as well.Results All patients were followed up for 15-18 months[(15.9±1.3)months].The operation time in plate group[(150.6±24.2)minutes]was longer than that in screw group[(126.8±18.3)minutes](P<0.05).There was no significant difference in fracture healing time or VAS between the two groups(P>0.05).After 1,3,6 months and during the last follow-up,the range of motion of elbow joint flexion and extension in plate group[(87.2±5.8)°,(109.2±7.1)°,(121.3±6.2)°,(127.3±5.4)°]was higher than that in screw group[(70.5±9.1)°,(90.2±4.5)°,(108.3±5.1)°,(116.2±4.6)°],the range of motion of forearm rotation in plate group[(78.3±9.1)°,(98.7±8.6)°,(130.2±7.1)°,(139.2±6.7)°]was higher than that in screw group[(60.1±5.1)°,(80.6±8.7)°,(116.1±5.5)°,(127.3±4.1)°],and the MEPS in plate group[(30.6±7.6)points,(68.1±6.1)points,(90.2±4.3)points,(95.2±2.1)points]was higher than that in screw group[(27.2±8.1)points,(54.1±7.1)points,(82.1±5.3)points,(88.2±5.2)points](all P<0.05).In plate group,one patient sustained superficial wound infection at postoperative 1 week,which was healed uneventfully after surgical debridement and antibiotic therapy;two patients had hetero
作者
王建兵
吴永伟
马运宏
刘军
周明
王鹏
罗俊浩
薛源
芮永军
Wang Jianbing;Wu Yongwei;Ma Yunhong;Liu Jun;Zhou Ming;Wang Peng;Luo Junhao;Xue Yuan;Rui Yongjun(Department of Orthopedics and Traumatology,Wuxi No.9 People's Hospital Affiliated to Soochow University,Wuxi Orthopedic Hospital,Wuxi 214062,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2021年第11期1006-1012,共7页
Chinese Journal of Trauma
关键词
肘关节
尺骨骨折
骨折固定术
内
Elbow joint
Ulna fractures
Fracture fixation,internal
