摘要
目的 探讨重建冠状突治疗合并冠状突缺损的陈旧性肘关节脱位的可行性与疗效.方法 2008年7月至2010年1月共收治6例合并冠状突缺损的陈旧性肘关节脱位患者,均为男性,手术时平均年龄30.5岁（18～42岁）;右侧4例,左侧2例.患者原始损伤均为肘部损伤＂三联征＂,伤后平均手术次数1.2次（1～2次）.均采用后侧切口行关节松解,松解后于肘关节伸肘位脱位,以自体鹰嘴尖或部分桡骨头重建冠状突,以螺钉或克氏针固定,并以Stryker铰链式外固定支架保护.术后第1天开始功能锻炼,并口服吲哚美辛预防异位骨化,外固定支架于术后8周去除.结果 6例患者皆获得较好的术中稳定性,重建冠状突后,伸肘位肘关节无明显后脱位趋势.术后平均随访12个月（3～21个月）.肘关节屈伸活动度由术前平均13.3°（0～35°）改善为术后120.0°（100°～140°）,前臂旋转活动度由术前平均62.5°（10°～140°）改善为术后141.7°（110°～170°）,Mayo肘关节功能评分由术前平均51.7分（50～55分）改善为术后97.5分（85～100分）.结论 以自体鹰嘴尖或部分桡骨头重建冠状突可显著增加合并冠状突缺损的肘关节稳定性,是治疗合并冠状突缺损的陈旧性肘关节脱位的一种较好方法.
Objective To report clinical results of reconstruction of the deficient coronoid to improve the elbow stability for the treatment of chronic elbow dislocation. Methods From July 2008 to January 2010, we preformed coronoid reconstruction with autogenous olecranon or radial head after arthrolysis for 6 patients with chronic elbow dislocation complicated with deficient coronoid. All the 6 patients were male, withan average age of 30.5 years （18 to 42 years） at the time of surgery. Four right and 2 left elbows were affected. The average time from injury to surgery was 5 months （2 to 11 months） . All the primary injuries were terrible triad. The average range of elbow motion before operation was 13.3° （0 to 35°）, and the average range of forearm rotation before operation was 62.5° （10° to 140°） . Through a standard posterior skin inci sion, the elbow joint was dislocated posteriorly in extension after arthrolysis to reconstruct the coronoid with autogenous olecranon or radial head. After fixation with screws or k-wires, the Stryker hinged external fixator was used for protection. Exercise began the first day after operation, Indomethacin was administered to prevent ectopic ossification. The external fixator was removed after 8 weeks. Results The mean follow-up time was 12 months （3 to 21 months） . The average range of elbow motion after operation was 120.0° （ 100° to 140°）, and the average range of forearm rotation after operation was 141.7° （110°to 170°） . The average Mayo elbow performance score increased from 51.7 （50 to 55） before operation to 97.5 （85 to 100） after operation. All the 6 elbows were stable in extension after coronoid reconstruction. Conclusion Since coronoid reconstruction with autogenous olecranon or radial head can substantially improve the elbow stability,it is a good treatment for chronic elbow dislocation complicated with deficient coronoid.
出处
《中华创伤骨科杂志》
CAS
CSCD
2010年第10期911-914,共4页
Chinese Journal of Orthopaedic Trauma
关键词
肘关节
脱位
创伤和损伤
功能恢复
Elbow joints
Dislocation
Wounds and injuries： Recovery of function
