肘关节内翻后内侧旋转不稳的手术疗效

doi:10.6040/j.issn.1671-7554.0.2016.228

摘要/Abstract

摘要： 目的探讨肘关节内翻后内侧旋转不稳定的诊疗流程和手术疗效。方法选取2011年12月至2014年11月采用内外侧联合入路治疗肘关节内翻-后内侧旋转不稳定患者15例,其中男9例,女6例,11~69岁,平均35.6岁。左侧7例,右侧8例。致伤原因:摔伤14例,车祸伤1例。冠状突骨折按O’Driscoll分型标准:Ⅱ1型9例,Ⅱ2型5例,Ⅱ3型1例。术前、术中和术后均在麻醉下行内翻、内旋和轴向应力位透视评估肘关节稳定性及肱桡关节间隙。所有患者均采用微型钢板或专用钢板固定,粉碎骨折结合克氏针固定,合并尖部骨折时加用缝合法固定,然后外侧入路探查并以锚钉修复重建外侧副韧带(LCL),患者无应用外固定支架。术后早期进行功能锻炼。结果所有患者术后获得12~30个月随访,平均18.7个月。骨折均获得临床愈合,愈合时间7~14周,平均10周。平均屈曲136.8°±3.3 °,平均伸直3.6°±1.3°,平均旋前86.8°±5.6°,平均旋后88.6°±3.5°。所有患者未出现肘关节不稳定、疼痛及肘内翻等并发症。上肢功能损伤(DASH)评分为2.5~12.5分,平均5.3分。Mayo肘关节功能评分标准(MEPS):优13例,良2例。结论手术治疗肘关节内翻-后内侧旋转不稳定可以获得足够的稳定性,允许早期功能锻炼,疗效满意,可明显降低肘内翻、关节快速退变及肘关节不稳定等并发症。

关键词: 肘关节, 骨折, 不稳, 手术治疗, 前内侧面, 冠状突

Abstract: Objective To explore a standard surgical protocol and observe the clinical outcomes of treating varus posteromedial rotational instability(VPRI)of the elbow. Methods A total of 15 VPRI cases surgically treated via the medial and lateral approach during Dec. 2011 and Nov. 2014 were involved, including 9 males and 6 females, aged 11 to 69 years, mean 35.6 years. Altogether 7 left and 8 right elbows were affected. Causes of injury included traffic injury in 1 case and fall on the ground from the standing position in 14 cases. O Driscoll classification showed 9 cases of type Ⅱ1, 5 cases of type Ⅱ2 and 1 case of type Ⅱ3. The elbow stability and the humeroradial joint space were assessed by applying varus, pronated and axial stresses onto the forearm under fluoroscopy after anesthesia pre-, intra- and postoperation. The fractures of the coronoid were fixed with mini-plates or special designed plates, combined with K-wires or lasso sutures when fracture comminuted or extended to tip, via the medial approach, then lateral Kocher approach was performed, and lateral collateral ligament(LCL)was repaired using suture anchors. No external fixator was used. Rehabilitation program was early initiated with the guidance of surgeons after operation. Results All cases were followed-up for 12 to 30 months(average 18.7 months). Bony union was achieved in all cases within 7 to 14 weeks, with an average of 10 weeks. The average flexion was(136.8°±3.3°), average extension(3.6°±1.3°), average pronation(86.8°±5.6°), average supination(88.6°±3.5°). No complications such as elbow instability, pain and cubitus varus occurred. According to the Mayo elbow performance score(MEPS), the results were excellent 山东大学学报 (医学版)54卷12期 -刘涛,等.肘关节内翻后内侧旋转不稳的手术疗效 \=-in 13 cases and good in 2 cases. The mean DASH(disabilities of the arm, shoulder and hand)score was 5.3(2.5 to 12.5). Conclusion Using standard surgical protocol for elbow varus posteromedial rotational instability can restore sufficient elbow stability to allow early motion, enhance the functional outcome, and reduce the overall complications such as cubitus varus, early degenerative changes and instability.

Key words: Elbow joint, Coronoid process, Anteromedial facet, Surgical treatment, Instability, Fracture

中图分类号:

R684.7

刘涛,鲍飞龙,高伟,亢世杰,吕夫新,胡义明. 肘关节内翻后内侧旋转不稳的手术疗效[J]. 山东大学学报（医学版）, 2016, 54(12): 41-45.

LIU Tao, BAO Feilong, GAO Wei, KANG Shijie, LÜ Fuxin, HU Yiming. A standard surgical protocol and outcome of treating varus posteromedial rotational instability of elbow[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(12): 41-45.

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