中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2014年
9期
744-749
,共6页
查晔军%蒋协远%公茂琪%王满宜
查曄軍%蔣協遠%公茂琪%王滿宜
사엽군%장협원%공무기%왕만의
肘关节%骨折%脱位%桡骨头%冠状突
肘關節%骨摺%脫位%橈骨頭%冠狀突
주관절%골절%탈위%뇨골두%관상돌
Elbow joint%Fractures,bone%Dislocations%Radial head%Coronoid process
目的 介绍经单一外侧切口(劈指总伸肌入路)治疗肘关节“三联征”的手术方法及效果. 方法 回顾性分析自2011年7月至2013年6月采用单一外侧切口治疗的23例肘关节“三联征”患者的临床资料,男14例,女9例;年龄16 ～ 68岁,平均42.1岁.冠状突骨折均采用经骨孔套索缝合前关节囊结合克氏针固定.桡骨头骨折:14例行HCS固定,9例行人工桡骨头假体置换.6例在肱骨外上髁钻孔后以2号爱惜邦线编织缝合对外侧副韧带复合体加伸肌总腱起点进行修复,17例采用缝合锚进行修复.20例患者采用Stryker DJDⅡ铰链式外固定支架固定以保护骨与软组织的修复. 结果 所有患者术后获6 ～ 30个月(平均19.0个月)随访.末次随访时所有患者的术后功能均能满足日常生活需要,无二期松解的患者,平均屈肘137.0°±8.8°,平均伸肘-4.8°±15.0°,平均屈伸活动范围为132.2°±21.5°;前臂平均旋前88.7°±6.3°,平均旋后89.6°±2.1°,平均旋转活动范围178.3°±6.5°;平均Mayo肘关节功能评分为(97.4±6.9)分.所有患者均未发生明显疼痛、不稳定、感染及神经损伤等并发症. 结论 肘关节“三联征”有明显骨性阻挡时采用单一外侧切口(劈指总伸肌入路)可获得良好的结果.若骨折较粉碎或固定后仍不稳定,可附加铰链式外固定支架保护.
目的 介紹經單一外側切口(劈指總伸肌入路)治療肘關節“三聯徵”的手術方法及效果. 方法 迴顧性分析自2011年7月至2013年6月採用單一外側切口治療的23例肘關節“三聯徵”患者的臨床資料,男14例,女9例;年齡16 ～ 68歲,平均42.1歲.冠狀突骨摺均採用經骨孔套索縫閤前關節囊結閤剋氏針固定.橈骨頭骨摺:14例行HCS固定,9例行人工橈骨頭假體置換.6例在肱骨外上髁鑽孔後以2號愛惜邦線編織縫閤對外側副韌帶複閤體加伸肌總腱起點進行脩複,17例採用縫閤錨進行脩複.20例患者採用Stryker DJDⅡ鉸鏈式外固定支架固定以保護骨與軟組織的脩複. 結果 所有患者術後穫6 ～ 30箇月(平均19.0箇月)隨訪.末次隨訪時所有患者的術後功能均能滿足日常生活需要,無二期鬆解的患者,平均屈肘137.0°±8.8°,平均伸肘-4.8°±15.0°,平均屈伸活動範圍為132.2°±21.5°;前臂平均鏇前88.7°±6.3°,平均鏇後89.6°±2.1°,平均鏇轉活動範圍178.3°±6.5°;平均Mayo肘關節功能評分為(97.4±6.9)分.所有患者均未髮生明顯疼痛、不穩定、感染及神經損傷等併髮癥. 結論 肘關節“三聯徵”有明顯骨性阻擋時採用單一外側切口(劈指總伸肌入路)可穫得良好的結果.若骨摺較粉碎或固定後仍不穩定,可附加鉸鏈式外固定支架保護.
목적 개소경단일외측절구(벽지총신기입로)치료주관절“삼련정”적수술방법급효과. 방법 회고성분석자2011년7월지2013년6월채용단일외측절구치료적23례주관절“삼련정”환자적림상자료,남14례,녀9례;년령16 ～ 68세,평균42.1세.관상돌골절균채용경골공투색봉합전관절낭결합극씨침고정.뇨골두골절:14례행HCS고정,9례행인공뇨골두가체치환.6례재굉골외상과찬공후이2호애석방선편직봉합대외측부인대복합체가신기총건기점진행수복,17례채용봉합묘진행수복.20례환자채용Stryker DJDⅡ교련식외고정지가고정이보호골여연조직적수복. 결과 소유환자술후획6 ～ 30개월(평균19.0개월)수방.말차수방시소유환자적술후공능균능만족일상생활수요,무이기송해적환자,평균굴주137.0°±8.8°,평균신주-4.8°±15.0°,평균굴신활동범위위132.2°±21.5°;전비평균선전88.7°±6.3°,평균선후89.6°±2.1°,평균선전활동범위178.3°±6.5°;평균Mayo주관절공능평분위(97.4±6.9)분.소유환자균미발생명현동통、불은정、감염급신경손상등병발증. 결론 주관절“삼련정”유명현골성조당시채용단일외측절구(벽지총신기입로)가획득량호적결과.약골절교분쇄혹고정후잉불은정,가부가교련식외고정지가보호.
Objective To report the surgical techniques and results of treating the coronoid process and radial head fracture with dislocation of the elbow (terrible triad of the elbow) using a single lateral incision,the extensor digitorium communis (EDC) split approach.Methods A retrospective analysis was done of 23 patients with terrible triad of the elbow who had been treated by the authors from July 2011 to June 2013.They were 14 males and 9 females,with a mean age of 42.1 years (from 16 to 68 years).All patients were treated via a single lateral approach.The coronoid process was fixated by Kirschner wires combined with the anterior capsule suture lasso fixation.For the radial head fracture,14 cases were fixated by AO HCS and 9 cases by Acumed radial head replacement.In repair of the lateral collateral ligament complex and the common extensor tendon,6 cases used No.2 Ethibon suture through bone holes at the humeral lateral epicondyle,and the other 17 cases used suture anchors.No medial collateral ligament was repaired.Twenty patients were fixated by Stryker DJD Ⅱ hinged external fixator to protect the bone and soft tissue.Results All patients were followed up from 6 to 30 months (mean,19.0 months).The last follow-ups revealed that all patients recovered daily functions of the elbow with no need of secondary release.Their elbow flexion averaged 137.0° ± 8.8°,elbow extension-4.8° ± 15.0°,range of flexion and extension 132.2° ± 21.5°,forearm pronation 88.7° ± 6.3°,forearm supination 89.6° ± 2.1°,forearm rotation 178.3° ± 6.5°,and Mayo elbow performance score(MEPS) 97.4 ± 6.9 points.No obvious pain,instability,infection,or ulnar nerve symptoms was observed.Conclusions The elbow terrible triad with bone blocking can be treated by a simple lateral incision (the EDC split approach) to repair and fix the anterior capsule + coronoid process fracture,radial head fracture,and the lateral collateral ligament complex and the common extensor tendon.If the elbow is still unstable,it is advisable to add the hinged external fixator to protect the bone and soft tissue without repairing the medial structure by another incision,minimizing injury to the elbow,elbow stiffness and ulnar nerve lesions.
