探讨经鹰嘴肘关节骨折脱位的骨折特点及手术策略。

回顾性分析2013年1月至2018年1月山东大学附属省立医院采用切开复位内固定治疗的24例经鹰嘴肘关节骨折脱位患者的临床资料及随访结果，其中男性13例，女性11例。年龄25 ~ 64岁，平均36.4岁。受伤原因为：交通伤12例、高坠伤6例、摔伤6例。尺骨鹰嘴横型或斜型骨折4例，粉碎性骨折20例；合并冠突骨折15例，根据Regan-Morrey分型均为III型；合并桡骨头骨折2例。受伤至手术时间为7 ~ 19 d，平均10.5 d。所有患者均采用肘关节后方正中入路复位固定冠突、桡骨头和尺骨鹰嘴骨折，恢复滑车切迹解剖完整性。其中2例患者因冠突固定欠佳，加用肘前方入路复位固定冠突骨折。

所有患者术后均获得随访，随访时间12 ~ 24个月，平均13.2个月。所有骨折均获得骨性愈合，平均愈合时间为（2.8±0.5）个月。术后12个月Mayo肘关节功能评分平均为（85.1±4.1）分,其中优8例，良12例，可4例，优良率83.3%。所有患者末次随访均未出现创伤性关节炎、肘关节不稳定、骨折不愈合等并发症。

经鹰嘴肘关节骨折脱位是一种发病率较低的复杂损伤，可涉及尺骨鹰嘴、冠突及桡骨头骨折。良好地复位及牢固固定各骨折块，尤其是滑车切迹的平整，同时术后积极规范的功能锻炼，可以获得很好的临床效果。

Trans-olecranon fracture-dislocation of the elbow refers to a complex injury of olecranon fracture combined with anterior dislocation of the ulna and radius while the proximal radioulnar joint remains intact. It was first reported by Biga and Thomine in 1974. The incidence of this type of injury is low, and the injury mechanism and fracture characteristics were not well understood in the early stage. It is easy to be misdiagnosed as Bado typeⅠ Monteggia fracture, terrible triad, single olecranon fracture, etc., thereby increasing the difficulty of treatment and the complications risk. Recently, with the rising of awareness and the improvement of equipment, there were few reports in the literatures on whether the treatment effect of such injuries was improved.

To investigate the fracture characteristics and surgical strategy of trans-olecranon fracture-dislocation of the elbow.

From January 2013 to January 2018, the clinical data and follow-up results of 24 patients with trans-olecranon fracture-dislocation of the elbow were retrospectively analyzed, including 13 males and 11 females. Their ages range from 25 to 64 years, with an average of 36.4 years. Causes of injuries: 12 cases of traffic injuries, 6 cases of high fall injuries and 6 cases of fall damages. There were 4 cases of transverse or oblique olecranon fractures, 20 cases of comminuted olecranon fractures, and 15 cases of coronal process fractures. All of them were type III according to Regan-Morrey classification, including 2 cases combined with radius head fractures. The time from injury to operation were 7-19 days, with an average of 10.5 days. All patients were treated through posterior approach to reduce and fix fractures of coronal process, radial head and olecranon, and restore the anatomical integrity of trochlear notch. Two of the patients had poor fixation of the coronary process, and the anterior elbow approach was used for fixation.

All patients were followed up for 12 to 24 months, with an average of 13.2 months. Bone union was achieved in all fractures, with an average healing time of (2.8±0.5) months. The mean Mayo score at 12 months after operation was (85.1±4.1) . Among them, 8 cases were excellent, 12 cases were good and 4 cases were moderate. The excellent and good rate was 83.3%. No complications such as traumatic arthritis, elbow joint instability or fracture nonunion occurred during the last follow-up.

Trans-olecranon fracture-dislocation of the elbow is a complex injury with low incidence, which may include fractures of olecranon, coronoid process and radial head. Good reduction and firm fixation of all fracture fragments, especially the trochlear notch, and standardized functional exercise after operation can achieve good clinical results.