外科研究与新技术
外科研究與新技術
외과연구여신기술
SURGICAL RESEARCH AND NEW TECHNIQUE
2012年
1期
69-75
,共7页
张世民%祝晓忠%黄轶刚%王欣
張世民%祝曉忠%黃軼剛%王訢
장세민%축효충%황질강%왕흔
恐怖三联征%肘关节%内侧副韧带
恐怖三聯徵%肘關節%內側副韌帶
공포삼련정%주관절%내측부인대
Terrible triad injury%Elbow dislocation%Medial collateral ligament
目的 肘关节恐怖三联征除了X片可见的后脱位和桡骨头及尺骨冠突骨折外,还有广泛的软组织损害.本文根据肘关节内侧副韧带(MCL)损伤如否,将肘关节恐怖三联征分为2个亚型并探讨其临床意义.方法 2004-2009年,共治疗7例肘关节恐怖三联征,其中Ⅰ型2例(MCL完整)保守治疗,石膏固定2~3周后功能锻炼;Ⅱ型5例(MCL断裂)手术治疗,经内外侧双切口显露,分别固定桡骨头和冠突,修复外侧副韧带和内侧副韧带.结果 7例患者获得1~4年随访(平均2年).骨折愈合,肘关节稳定,活动无疼痛.活动幅度屈伸平均120°,旋转100°,MEPS评分优5例,良2例.结论 在肘关节恐怖三联征中,MCL完整者,其桡骨头和冠突骨折的类型和移位均较轻,可保守治疗;MCL断裂者,其骨折类型和移位均较重,需手术治疗.修复MCL能显著提高肘关节的稳定性.
目的 肘關節恐怖三聯徵除瞭X片可見的後脫位和橈骨頭及呎骨冠突骨摺外,還有廣汎的軟組織損害.本文根據肘關節內側副韌帶(MCL)損傷如否,將肘關節恐怖三聯徵分為2箇亞型併探討其臨床意義.方法 2004-2009年,共治療7例肘關節恐怖三聯徵,其中Ⅰ型2例(MCL完整)保守治療,石膏固定2~3週後功能鍛煉;Ⅱ型5例(MCL斷裂)手術治療,經內外側雙切口顯露,分彆固定橈骨頭和冠突,脩複外側副韌帶和內側副韌帶.結果 7例患者穫得1~4年隨訪(平均2年).骨摺愈閤,肘關節穩定,活動無疼痛.活動幅度屈伸平均120°,鏇轉100°,MEPS評分優5例,良2例.結論 在肘關節恐怖三聯徵中,MCL完整者,其橈骨頭和冠突骨摺的類型和移位均較輕,可保守治療;MCL斷裂者,其骨摺類型和移位均較重,需手術治療.脩複MCL能顯著提高肘關節的穩定性.
목적 주관절공포삼련정제료X편가견적후탈위화뇨골두급척골관돌골절외,환유엄범적연조직손해.본문근거주관절내측부인대(MCL)손상여부,장주관절공포삼련정분위2개아형병탐토기림상의의.방법 2004-2009년,공치료7례주관절공포삼련정,기중Ⅰ형2례(MCL완정)보수치료,석고고정2~3주후공능단련;Ⅱ형5례(MCL단렬)수술치료,경내외측쌍절구현로,분별고정뇨골두화관돌,수복외측부인대화내측부인대.결과 7례환자획득1~4년수방(평균2년).골절유합,주관절은정,활동무동통.활동폭도굴신평균120°,선전100°,MEPS평분우5례,량2례.결론 재주관절공포삼련정중,MCL완정자,기뇨골두화관돌골절적류형화이위균교경,가보수치료;MCL단렬자,기골절류형화이위균교중,수수술치료.수복MCL능현저제고주관절적은정성.
Objective Besides radial head and coronoid fractures,terrible triad injury of the elbow involves a wide range of soft-tissue ruptures.The paper proposes a classification of the terrible triad injury with special reference to the status of medial collateral ligament (MCL).Methods From 2004 to 2009,seven patients with terrible triad injury were treated consecutively.There were 2 in type Ⅰ (MCL-intact) managed conservatively and 5 in type Ⅱ (MCL-ruptured) managed surgically.The operation involved lateral and medial double approaches.The fractures were screw or suture fixed.The lateral collateral ligament (LCL) was repaired by sutures through drilled holes or bone anchors.The elbow was not concentric reduced during intraoperative forearm weight test,and then the MCL was further repaired.Results All 7 patients were followed up for 1-4 years (average 2 years),with healed fracture,stable elbow and no pain movement.The average range of motion was 120 degrees in flexion-extension,100 degrees in pronation-supination.The functional outcome was excellent in 5 and good in 2 according to Mayo Elbow Performance Score.Conclusion Terrible triad injury with MCL-intact was related with minor radial head and coronoid fractures and displacement and may be managed conservatively,while with MCL-ruptured,relevant to major fractures and displacement,and should be treated surgically.Further MCL repair enhances the stability greatly in terrible triad of the elbow.