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.

参考文献

[1] Odriscoll SW, Jupiter JB, Cohen MS, et al. Difficult elbow fractures: pearls and pitfalls[J]. Instr Course Lect, 2003, 52: 113-134.
[2] Doornberg JN, Ring D. Coronoid fracture patterns[J]. J Hand Surg Am, 2006, 31(1): 45-52.
[3] Doornberg JN, Ring DC. Fracture of the anteromedial facet of the coronoid process[J]. J Bone Joint Surg Am, 2006, 88(10): 2216-2224.
[4] Ring D. Fractures of the coronoid process of the ulna[J]. J Hand Surg Am, 2006, 31(10): 1679-1689.
[5] Ring D, Jupiter JB. Surgical exposure of coronoid fractures[J]. Techniques in Shoulder & Elbow Surgery, 2002, 3(1): 48-56.
[6] Beingessner DM, Dunning CE, Stacpoole RA, et al. The effect of coronoid fractures on elbow kinematics and stability[J]. Clin Biomech(Bristol, Avon), 2007, 22(2): 183-190.
[7] Doornberg JN, De Jong IM, Lindenhovius AL, et al. The anteromedial facet of the coronoid process of the ulna[J]. J Shoulder Elbow Surg, 2007, 16(5): 667-670.
[8] Forthman C, Henket M, Ring DC. Elbow dislocation with intra-articular fracture: the results of operative treatment without repair of the medial collateral ligament[J]. J Hand Surg Am, 2007, 32(8): 1200-1209.
[9] Steinmann SP. Coronoid process fracture[J]. J Am Acad Orthop Surg, 2008, 16(9): 519-529.
[10] Budoff JE. Coronoid fractures[J]. J Hand Surg Am, 2012, 37(11): 2418-2423.
[11] Park SM, Lee JS, Jung JY, et al. How should anteromedial coronoid facet fracture be managed? A surgical strategy based on ODriscoll classification and ligament injury[J]. J Shoulder Elbow Surg, 2015, 24(1): 74-82.
[12] Ramirez MA, Stein JA, Murthi AM. Varus Posteromedial Instability[J]. Hand Clin, 2015, 31(4): 557-663.
[13] Rhyou IH, Kim KC, Lee JH, et al. Strategic approach to ODriscoll type 2 anteromedial coronoid facet fracture[J]. J Shoulder Elbow Surg, 2014, 23(7): 924-932.
[14] Ring D, Horst TA. Coronoid fractures[J]. J Orthop Trauma, 2015, 29(10): 437-440.
[15] 蒋协远, 查晔军, 公茂琪,等. 肘关节内翻-后内侧旋转不稳定的诊断与治疗[J]. 中华创伤骨科杂志, 2012, 1(14): 3-7. JIANG Xieyuan, ZHA Yejun, GONG Maoqi, et al. Diagnosis and treatment of elbow varus posteromedial rotational instability[J]. Chinese Journal of Orthopaedic Trauma, 2012, 1(14): 3-7.
[16] Hotchkiss RN, Kasparyan GN. The Medial “Over the Top” Approach to the Elbow[J]. Techniques in Orthopaedics June, 2000, 15(2): 105-112.
[17] Garrigues GE, Wray WH 3rd, Lindenhovius AL, et al. Fixation of the coronoid process in elbow fracture-dislocations[J]. J Bone Joint Surg Am, 2011, 93(20): 1873-1881.
[18] Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH(disabilities of the arm, shoulder and hand)[corrected]. The Upper Extremity Collaborative Group(UECG)[J]. Am J Ind Med, 1996, 29(6): 602-608.
[19] Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid[J]. Instr Course Lect, 1995, 44: 175-185.
[20] Court-Brown CM, Heckman JD, McQueen MM, et al. Rockwood and Greens Fractures in Adults[M].8th ed. Philadelphia: Lippincott Williams & Wilkins, 2015: 1181-1229.
[21] Moon JG, Bither N, Jeon YJ, et al. Non surgically managed anteromedial coronoid fractures in posteromedial rotatory instability: three cases with 2 years follow-up[J]. Arch Orthop Trauma Surg, 2013, 133(12): 1665-1668.
[22] Sanchez-Sotelo J, Odriscoll SW, Morrey BF. Medial oblique compression fracture of the coronoid process of the ulna[J]. J Shoulder Elbow Surg, 2005, 14(1): 60-64.
[23] Van Der Werf HJ, Guitton TG, Ring D. Non-operatively treated fractures of the anteromedial facet of the coronoid process: a report of six cases[J]. Shoulder & Elbow, 2010, 2(1): 40-42.
[24] Cheung EV, Steinmann SP. Surgical approaches to the elbow[J]. J Am Acad Orthop Surg, 2009, 17(5): 325-333.
[25] Taylor TK, Scham SM. A posteromedial approach to the proximal end of the ulna for the internal fixation of olecranon fractures[J]. J Trauma, 1969, 9(7): 594-602.

相关文章 15

[1]	林锦秀,李晔,尹德超,王鲲鹏,谭宝利. 基于CT三维成像的难复性股骨粗隆间骨折分型与治疗[J]. 山东大学学报 (医学版), 2025, 63(12): 61-73.
[2]	黄艳,周应芳,彭超. 青少年子宫内膜异位症的管理要点和策略[J]. 山东大学学报 (医学版), 2025, 63(10): 8-12.
[3]	张迪,聂辰宇,刘继东,侯新国,陈丽. 常染色体显性遗传骨硬化症Ⅱ型的2例家系报道及文献复习[J]. 山东大学学报 (医学版), 2024, 62(6): 82-90.
[4]	张杨,李晓旭. 加速康复外科理念在骨折治疗中的研究进展[J]. 山东大学学报 (医学版), 2024, 62(10): 18-25.
[5]	唐宁,黄晓莉,宋桂花. 老年髋部骨折手术患者营养管理研究进展[J]. 山东大学学报 (医学版), 2024, 62(10): 42-47.
[6]	马臣帮,高沛,常耀,毛昌琳,陈峰,朱可嘉,管勇,李善军,丁森泰. 非结节性硬化症双肾巨大血管平滑肌脂肪瘤精准诊断及同期两侧手术治疗1例及文献复习[J]. 山东大学学报 (医学版), 2023, 61(2): 65-71.
[7]	张明慧,王丽云,王芸,张新月,沙凯辉. 髋部骨折患者术后恐动症风险的列线图分析[J]. 山东大学学报 (医学版), 2023, 61(11): 74-81.
[8]	曾彦平,闫圣涛,刘小瑜,江子晴. 以甲状旁腺危象为首发表现的甲状旁腺癌1例文献报道[J]. 山东大学学报 (医学版), 2023, 61(1): 62-68.
[9]	林均馨,刘玉江,刘培来,万连平,张鹏,杜建春,刘泽淼,孔杰,高升焘. 固定平台单髁术后胫骨假体周围骨折2例[J]. 山东大学学报 (医学版), 2022, 60(3): 96-99.
[10]	靳鲁珺,林雪艳,刘天航,李青,李晓文,房蕾,孙浩,田永杰. 重度盆腔器官脱垂患者治疗选择及影响因素[J]. 山东大学学报 (医学版), 2022, 60(12): 39-43.
[11]	田吉光,王志勇,程林,桑锡光. 一种新式骨盆及髋臼通道螺钉的置钉方法[J]. 山东大学学报 (医学版), 2022, 60(10): 17-26.
[12]	王沂峰,何丽清. 外阴癌腹股沟淋巴结手术的研究进展[J]. 山东大学学报 (医学版), 2021, 59(9): 103-109.
[13]	张琳,王燕,马旭,范雪松,袁慧. 不稳定心绞痛患者亚甲基四氢叶酸还原酶基因多态性与血清同型半胱氨酸的相关性[J]. 山东大学学报 (医学版), 2021, 59(6): 71-75.
[14]	霍素霞,刘薇,王鑫. 86例Ⅲ型瘢痕妊娠诊治体会[J]. 山东大学学报 (医学版), 2021, 59(1): 40-44.
[15]	孙志刚,时鹏,田兴松. 乳腺癌术后促纤维增生性肌纤维母细胞瘤1例[J]. 山东大学学报 (医学版), 2020, 58(1): 121-124.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed