摘要
目的探讨渐次评估肘关节稳定性,分步修复稳定性结构在治疗肘关节骨折脱位中的意义。方法对2005年4月至2012年3月,在我院收治的41例肘关节骨折脱位患者进行回顾分析。术前评估,依据影像学评估骨性结构的破坏情况,判定肘关节失稳的主要因素,分主次、先后予以修复;术中评估,骨性结构修复后进行应力试验,评估关节囊韧带损伤情况分别予以修复。术后评估,评估肘关节整体稳定性,决定是否予以肘关节的辅助稳定,并及时予以康复锻炼,随访治疗效果。结果 41例术前评估认定为复杂孟氏骨折10例;恐怖三联征14例;经尺骨鹰嘴前脱位9例;单纯冠状突骨折合并脱位4例;单纯桡骨头骨折合并脱位4例。术中评估,发现关节囊韧带复合体损伤者34例,其中23例骨性结构修复后肘关节仍失稳,并对其中的18例内外侧韧带损伤者实施修复。术后评估,进行骨性修复与软组织修复后,9例肘关节存在半脱位倾向与摇摆不稳,需要支具、石膏、克氏针等辅助固定。平均随访10.4个月,41例骨折均愈合。依据日本骨科学会(Japanese orthopedic association,JOA)肘关节功能评估表,优者12例,良者19例,可者7例,差者3例。结论渐次评估骨折脱位的肘关节稳定性,可以更全面地发现肘关节不稳的影响因素,有针对性地进行修复,从而能更好地恢复肘关节功能。
Objective To discuss the significance of evaluating the gradual stability of the elbow joint with fracture-dislocation and repairing the bone and soft tissue structure step by step. Methods A total of 41 patients with elbow fracture-dislocation, treated in our hospital from April 2005 to March 2012, were studied retrospectively. Before the operation, the bone structure was evaluated according to the iconography to determine which type of injury was the main factor causing the instability and the operation plan was made. During the operation, the stress test was performed to evaluate the capsular ligament injury when the fracture was treated. The elbow stability was evaluated again after the operation to make sure whether it needed an assistant instrument and when to perform the function training. Results All 41 patients were evaluated before the operation according to the iconography. Ten cases were of complicated Monteggia fracture, 14 cases were terrible triad injury, 9 cases were transolecranon anterior dislocation, 4 cases were coronoid process fracture with dislocation, and 4 cases were radium head fracture with elbow dislocation. Thirty-four cases were found capsular ligament complex injury during the operation. Twenty-three cases were still instable after the bone structure was repaired and 18 cases among them got collateral ligament repaired. After the operation, 9 cases were instable and got assistant fixation with brace, plaster or K-wire. The average follow-up time was 10.4 months. All fractures were healed. According to the JOA Evaluation Sheet, 12 cases were excellent, 19 cases were good, 7 cases were fair and 3 cases were poor. Conclusions Gradual evaluation of the stability of the elbow joint fracture-dislocation can help to find factors causing instability and further get better function.
出处
《中国骨与关节杂志》
CAS
2016年第4期251-255,共5页
Chinese Journal of Bone and Joint
关键词
肘关节
尺骨
桡骨
骨折
肘关节脱位
Elbow joint
Ulna
Radius
Fractures
bone
Dislocation
elbow joint
