摘要
目的 探讨自体肌腱双骨隧道重建桡侧尺副韧带（lateral ulnar collateral ligament,LUCL）治疗肘关节后外侧旋转不稳定（posterolateral rotatory instability,PLRI）的手术疗效。方法 2008年1月至2013年12月成都大学附属医院收治16例LUCL损伤患者,11例用双束编制的掌长肌腱对韧带进行重建,5例用对侧半腱肌肌腱重建LUCL治疗肘关节PLRI,移植肌腱穿过肱骨及尺骨双骨隧道带线锚钉固定。观察术后肘关节活动度、肘关节侧方轴移试验、外翻外旋应力位X线片。结果所有患者均获随访,随访时间1~5年,平均2.5年。患者肘关节活动功能明显改善,主观满意,被动外翻、外旋活动时肘关节完全稳定12例,部分不稳定但较术前明显改善4例,优良率为75%。术后Mayo评分65~100分,平均85分,新鲜损伤患者术后功能明显好于陈旧性损伤患者（P〈0.05）。结论 LUCL是影响肘关节PLRI最主要的结构,采用自体肌腱肱骨及尺骨双骨隧道重建LUCL效果良好。
Background The concept of posterolateral rotatory instability （PLRI）of the elbow was proposed in 1991 by O′Driscoll for the first time.The pathogenic mechanism of PLRI is injury to the radial collateral ligament complex at the elbow,among which the lateral ulnar collateral ligament （LUCL） plays a major role. However, because most physicians know little about the elbow dysfunction caused by such ligament inj ury,missed or delayed diagnosis often prevents timely and effective treatment,leading to seriously impact on the quality of life of patients.Surgical treatment is often very effective,but surgical approaches vary a lot.Rhyou et al established a horizontal bone tunnel cross the humerus for passing through the tendon,but this approach doesn′t allow attachment of the upper end of this ligament on the lateral condyle of the humerus. Sanchez-Sotelo et al. established bone tunnel on ulna and humerus perpendicular to the ligament,and passed longer tendon through the tunnel at an＂8＂shape,which was immobilized by suture knot.This procedure requires that the tendon have to be a long and thin one while problems such as tendon breakage and suture slippage often happen.The way Dehlinger et al.established the bone tunnel was similar to the present study,i.e.,after passing the bone tunnel;the tendon was only fixed to the bone marrow with suture. This method also has the disadvantage of poor stability and delayed functional exercise.This study used autologous tendon and established humerus and ulna double bone tunnel for ligament reconstruction in 16 patients and the treatment effect is reported below.Methods From January 2008 to December 2013,orthopedics division of our hospital admitted and diagnosed 16 cases of elbow LUCL tear with PLRI patients,of which 11 males and 5 females,aged 19-43 years old,average age of 28.8 years old,7 cases of fresh injuries and 9 cases of old injuries,4 cases of simple ulnar coronoid process fracture,3 cases of elbow dislocation,5 cases of coronoid fracture with elbow dislocatio
出处
《中华肩肘外科电子杂志》
2016年第1期29-34,共6页
Chinese Journal of Shoulder and Elbow(Electronic Edition)
基金
国家自然科学基金(81500577)
关键词
肘关节
尺副韧带
韧带重建
Elbow joint
Ulnar collateral ligament
Ligament reconstruction
