冠状面固定对手术治疗急性复杂性肘关节不稳的功能结果和并发症发生率的影响。

Injury Pub Date : 2023-12-01 Epub Date: 2024-01-13 DOI:10.1016/j.injury.2023.110892
Samuel A Antuña, Riccardo Raganato, Lucia Ros Dopico, Raúl Barco
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引用次数: 0

摘要

导言:冠状突骨折常见于肘部骨折脱位。尽管有证据表明冠状突在肘关节稳定性方面发挥着重要作用,但对于哪些骨折应进行手术固定仍存在争议。本研究的目的是比较肘部骨折脱位患者在冠状突固定和不固定两种情况下的临床疗效和并发症发生率:对39名肘关节骨折脱位伴冠状突骨折的患者进行了平均90个月(24-190个月)的前瞻性随访。根据莫雷分类法,其中22例为II型,8例为III型。9名患者的冠状突前内侧骨折。24例患者的冠状突得到了修复(9例缝合固定,10例螺钉固定,5例钢板固定),15例患者的冠状突未得到固定。18名患者更换了桡骨头,8名患者固定了桡骨头。所有患者都进行了外侧韧带复合体修复。临床评估通过 MEPS 进行。在X光片上,对冠状骨不连的发生率进行了具体分析。记录了术后神经系统并发症:在最近的随访中,患者的平均屈伸弧度为 120°(范围为 70°-140°),平均 MEPS 为 90(范围为 25-100)。在MEPS和屈伸弧度方面,进行过综合治疗的患者(117° ROM和89 MEPS)与未进行综合治疗的患者(122° ROM和94 MEPS)之间没有发现明显的统计学差异(P = 0.42;P = 0.34)。有36名患者的冠状面骨折愈合情况可以进行评估:19名患者的冠状面骨折在影像学上已经愈合,17名患者的冠状面骨折出现了不愈合,两组患者的最终临床结果没有差异。9名患者(其中6人接受了冠状突固定术)出现了与尺神经有关的神经并发症:结论:只要骨韧带结构的其他部分得到充分修复,影响约50%高度的冠状面骨折无需内固定即可治疗。通过内侧入路对冠状面进行骨合成可能会带来不可忽视的相关神经损伤风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Influence of Coronoid fixation on the functional outcome and rate of complications in surgically treated acute complex elbow instability.

Introduction: Fractures of the coronoid commonly present in elbow fracture-dislocations. Despite the evidence that the coronoid plays an important role in elbow stability, there is still controversy on which fractures should be surgically fixed. The aim of this study is to compare the clinical outcomes and rate of complications of patients with elbow fracture-dislocations in which the coronoid was fixed or left untreated.

Materials and methods: Thirty-nine patients with an elbow fracture-dislocation involving a coronoid fracture were prospectively followed for an average of 90 months (range 24-190). According to Morrey´s classification there were 22 type II and 8 type III. Nine patients had an anteromedial fracture of the coronoid. In 24 patients the coronoid was repaired (suture fixation in 9, screws fixation in 10 and plate fixation in 5) and in 15 patients the coronoid was not fixed. In 18 patients the radial head was replaced and in 8 patients it was fixed. All patients underwent repair of the lateral ligament complex. Clinical evaluation was performed with the MEPS. Radiographically, the rate of coronoid nonunion was specifically analyzed. Postoperative neurological complications were recorded.

Results: At the most recent follow up, the average arc of flexion-extension was 120° (range 70°-140°) with a mean MEPS of 90 (range 25-100). No statistically significant differences were found in the MEPS and flexion-extension arc between the patients in whom synthesis was performed (117° ROM, and 89 MEPS) and those in whom it was not (122° ROM, 94 MEPS) (p = 0.42; p = 0.34). Coronoid fracture healing could be assessed in 36 patients: in 19 patients the coronoid was radiographically healed, and in 17 a nonunion was present, with no difference in the final clinical outcome between both groups. Nine patients, 6 of whom had undergone coronoid fixation, had a neurological complication related to the ulnar nerve.

Conclusions: Coronoid fractures affecting around 50% of its height can be treated without internal fixation as long as the rest of the osteo-ligamentous structures are adequately repaired. Osteosynthesis of the coronoid through a medial approach may carry a non-negligible risk of associated neurological injury.

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