中国临床实用医学
中國臨床實用醫學
중국림상실용의학
CHINA CLINICAL PRACTICAL MEDICINE
2010年
4期
54-56
,共3页
张骞%吕凌燕%尚博%张劼%都芳涛
張鶱%呂凌燕%尚博%張劼%都芳濤
장건%려릉연%상박%장할%도방도
肘关节恐怖三联征%内侧副韧带重建%桡骨小头切除
肘關節恐怖三聯徵%內側副韌帶重建%橈骨小頭切除
주관절공포삼련정%내측부인대중건%뇨골소두절제
Terrible triad of the elbow%Reconstruction of the medial collateral ligament%Radial head resection
目的 报告应用侧副韧带修补重建并桡骨小头切除手术方式治疗青年肘关节恐怖三联征、桡骨小头粉碎骨折患者的疗效观察.方法 自2005年11月至2009年10月,本院共收治肘关节三联征损伤3例.桡骨小头骨折按Mason法分类均为Ⅲ型.3例患者均行冠状突固定、肘内外侧副韧带、关节囊修补、内侧副韧带加强、重建并桡骨小头切除术,术后克氏针辅助固定肱尺关节于屈肘90°前臂旋转中立位,石膏固定3周,然后拔除克氏针,去除石膏,开始屈伸和旋转康复训练.结果 3例患者均随访1年以上,骨折愈合,按照Broberg和Morrey的肘关节功能评分2例为良,1例为可.结论 肘关节恐怖三联征伴有桡骨小头粉碎骨折的青年患者,韧带及关节囊的重建异常重要,桡骨小头置换应当审慎,在确保韧带重建满意的情况下切除桡骨小头并未造成肘关节明显功能障碍.
目的 報告應用側副韌帶脩補重建併橈骨小頭切除手術方式治療青年肘關節恐怖三聯徵、橈骨小頭粉碎骨摺患者的療效觀察.方法 自2005年11月至2009年10月,本院共收治肘關節三聯徵損傷3例.橈骨小頭骨摺按Mason法分類均為Ⅲ型.3例患者均行冠狀突固定、肘內外側副韌帶、關節囊脩補、內側副韌帶加彊、重建併橈骨小頭切除術,術後剋氏針輔助固定肱呎關節于屈肘90°前臂鏇轉中立位,石膏固定3週,然後拔除剋氏針,去除石膏,開始屈伸和鏇轉康複訓練.結果 3例患者均隨訪1年以上,骨摺愈閤,按照Broberg和Morrey的肘關節功能評分2例為良,1例為可.結論 肘關節恐怖三聯徵伴有橈骨小頭粉碎骨摺的青年患者,韌帶及關節囊的重建異常重要,橈骨小頭置換應噹審慎,在確保韌帶重建滿意的情況下切除橈骨小頭併未造成肘關節明顯功能障礙.
목적 보고응용측부인대수보중건병뇨골소두절제수술방식치료청년주관절공포삼련정、뇨골소두분쇄골절환자적료효관찰.방법 자2005년11월지2009년10월,본원공수치주관절삼련정손상3례.뇨골소두골절안Mason법분류균위Ⅲ형.3례환자균행관상돌고정、주내외측부인대、관절낭수보、내측부인대가강、중건병뇨골소두절제술,술후극씨침보조고정굉척관절우굴주90°전비선전중립위,석고고정3주,연후발제극씨침,거제석고,개시굴신화선전강복훈련.결과 3례환자균수방1년이상,골절유합,안조Broberg화Morrey적주관절공능평분2례위량,1례위가.결론 주관절공포삼련정반유뇨골소두분쇄골절적청년환자,인대급관절낭적중건이상중요,뇨골소두치환응당심신,재학보인대중건만의적정황하절제뇨골소두병미조성주관절명현공능장애.
Objective To observe the results of medial collateral ligament reconstruction plus radial head resection in the treatment of terrible triad of the elbow for young patients. Methods From November 2005 to October 2009,3 cases of terrible triad of the elbow were treated in our hospital. The radial head fractures were classified in type Ⅲ according to Mason classification. All patients underwent coronoid fixation, collateral ligament and joint capsule repair, medial collateral ligament reconstruction and radial head resection. Postoperatively Kirschner wire and the plaster was applied for elbow stabilization for 3 weeks after operation, in position with elbow flexion in 90 degrees and forearm rotation in neutral, and then removal of Kirschner wire and the plaster. Then physical exercise and rehabilitation program were carried out. Results 3 patients were followed up for more than 1 year with fracture healing. The functional outcome in 3 cases was excellent in 2 and good in 1 according to Broberg and Morrey Elbow Score. Conclusion It is exceptionally important of the reconstruction of collateral ligaments and joint capsule in the treatment of elbow terrible triad associated with radial head comminuted fracture for young patients. Radial head replacement should be cautious. Radial head resection under the premise of satisfactory ligament reconstruction does not cause significant elbow dysfunction.
