儿童尺骨冠状突骨骺骨折的临床治疗

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摘要目的〓探讨儿童尺骨冠状突骨骺骨折的特点与临床治疗方案。方法〓回顾性分析2014年1月至2023年1月四川省骨科医院儿童骨科收治的尺骨冠状突骨骺骨折102例患儿资料，男82例，女20例；左侧54例，右侧48例；年龄1岁11个月~14岁6个月，平均(9.53±3.27)岁。按Regan-Morrey分型，Ⅰ型49例，Ⅱ型27例，Ⅲ型26例。伴肘关节脱位39例，伴其他部位骨折75例。保守治疗59例，手术治疗43例。手术固定材料：空心钉+克氏针10例，克氏针9例，钢板24例。结果〓所有患儿均获得随访，随访时间10个月~4年9个月，平均(30.02±8.77)个月。按Mayo肘关节功能评价标准评定，优81例，良17例，可4例，优良率96.08%。结论〓儿童尺骨冠状突骨骺骨折常伴随其他骨折、肘关节脱位，预防漏诊需详溯病史及分析受伤机制，细致查体，摄伤肢X线片、CT平扫或MRI，Regan-Morrey Ⅰ型和骨折块小、移位少且肘关节稳定的骨折可采取保守治疗，粉碎性骨折、合并肘关节失稳的Regan-Morrey Ⅱ型及 Ⅲ型骨折更推荐前侧入路微型“T”型锁定钢板、空心钉或克氏针内固定，后期预后均较好。

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	孙强
	叶家军
	周英

关键词 ：儿童, 尺骨冠状突骨骺骨折, 内固定

Abstract：Objective〓To explore the characteristics and clinical treatment of ulnar coronal process epiphyseal fractures in children.Methods〓A retrospective analysis was performed on 102 children with ulnar coronal process epiphyseal fractures admitted to the Children's Orthopaedics Department of Sichuan Orthopaedics Hospital from January 2014 to January 2023.The cohort comprised 82 males and 20 females，with 54 fractures on the left side and 48 on the right.The age range was from 1 year，11 months to 14 years，6 months，with an average age of (9.53±3.27) years.Based on the Regan Morrey classification，there were 49 cases of type Ⅰ，27 cases of type Ⅱ，and 26 cases of type Ⅲ fractures.Among these cases，39 were accompanied by elbow joint dislocation，and 75 were accompanied by fractures in other body parts.Fifty-nine cases underwent conservative treatment，while 43 cases underwent surgical intervention.Surgical fixation materials included a combination of hollow nails and Kirschner wires in 10 cases，Kirschner wires alone in 9 cases，and steel plates in 24 cases.Results〓All patients were followed up for a duration ranging from 10 months to 4 years and 9 months，with an average follow-up period of (30.02±8.77)months.Based on the Mayo elbow joint function evaluation criteria，the outcomes were classified as 81 excellent cases，17 good cases，and 4 fair cases，resulting in an excellent and good rate of 96.08%.Conclusion〓Coronary process epiphyseal fractures of the ulna in children are frequently accompanied by additional fractures and elbow joint dislocations.To avoid misdiagnosis，it is crucial to thoroughly investigate the patient's medical history and injury mechanisms，conduct a detailed physical examination，capture lateral images of the injured limb，and perform a CT plain scan or MRI.For Regan-Morrey type I fractures and those with small fragments，minimal displacement，and a stable elbow joint，conservative treatment is often adopted.However，for comminuted fractures such as Regan-Morrey type Ⅱ and Ⅲ fractures，accompanied by elbow instability，fixation with micro T-shaped locking plates，hollow screws，or Kirschner wires through an anterior approach is more recommended，often resulting in a better prognosis in the later stages.

Key words： children epiphyseal fracture of coronoid process of ulna internal fixation

基金资助:四川省医学科研课题(S19065)
2023年度成都市医学科研课题(2023450)
四川省名中医周英工作室活态传承建设项目(川中医药办发［2022］16号)

作者简介: 孙强(1989－ )，男，主治医师，四川省骨科医院儿童骨科，2357401669@qq.com

引用本文:

孙强，叶家军，周英. 儿童尺骨冠状突骨骺骨折的临床治疗[J]. 实用骨科杂志, 2024, 30(6): 486-.
Sun Qiang，Ye Jiajun，Zhou Ying. Clinical Treatment of Epiphyseal Fracture of Coronoid Process of Ulna in Children. sygkzz, 2024, 30(6): 486-.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2024/V30/I6/486

［1］Lor KKH，Toon DH，Wee ATH.Buttress plate fixation of coronoid process fractures via a medial approach［J］.Chin J Traumatol，2019，22(5)：255-260.
［2］Sukegawa K，Suzuki T，Ogawa Y，et al.Anatomic cadaveric study of the extensile extensor digitorum communis splitting approach for exposing the ulnar coronoid process［J］.J Shoulder Elbow Surg，2016，25(8)：1268-1273.
［3］Sebastian F，Johannes R，Rudolf G，et al.Reconstruction for elbow instability caused by congenital aplasia of the ulnar coronoid process：A case report［J］.Acta Orthop，2016，87(1)：85-86.
［4］Ellwein A，Jensen G，Geerling J，et al.Neue operationsverfahren am ellenbogen［J］.Traumaund Berufskrankheit，2018，20(4s)：225-231.
［5］Beaty JH.Fractures and dislocations about the elbow［J］.Instr Course Lect，1992，41(3)：373-457.
［6］Tavassol F，Spalthoff S，Essig H，et al.Elongated coronoid process：CT-based quantitative analysis of the coronoid process and review of literature［J］.Int J Oral Maxillofac Surg，2012，41(3)：331-338.
［7］Chan K，Faber JK，King JG，et al.Selected anteromedial coronoid fractures can be treated nonoperatively［J］.J Shoulder Elbow Surg，2016，25(8)：1251-1257.
［8］吴永涛，孙川，汪兵，等.儿童分离型肘关节脱位的评估与治疗方案选择［J］.中华小儿外科杂志，2018，39 (11)：816-820.
［9］向明，杨国勇，胡晓川，等.肘关节前方血管神经间入路治疗尺骨冠状突骨折的中期研究［J］.中华骨科杂志，2018，38 (1)：8-15.
［10］Leschinger T，Müller PL，Hackl M，et al.Concomitant injury of the annular ligament in fractures of the coronoid process and the supinator crest［J］.J Shoulder Elbow Surg，2016，26(4)：604-610.
［11］Kan O，Daping W，Wei L，et al.Arthroscopic reduction and fixation of coronoid fractures with an exchange rod-a new technique.［J］.J Orthop Surg Res，2017，12(1)：9.
［12］Kiene J，Bogun J，Brockhaus N，et al.Biomechanical testing of a novel osteosynthesis plate for the ulnar coronoid process［J］.Shoulder Elbow，2014，6(3)：191-199.
［13］Alexander K，Stefan B，Yves G，et al.Good outcome using anatomically pre-formed buttress plates for anteromedial facet fractures of the coronoid-a retrospective study of twenty-four patients.［J］.Int Orthop，2019，43(12)：2817-2824.
［14］Valentin R，Michael H，Dominik S，et al.Plate osteosynthesis of the coronoid process of the ulna［J］.Operative Orthopadie und Traumatologie，2020，32(1)：35-46.
［15］Bellato E，O'Driscoll SW.Prosthetic replacement for coronoid deficiency：Report of three cases［J］.J Shoulder Elbow Surg，2016，26(3)：382-388.