肘关节尺侧副韧带的修复重建  

RECONSTRUCTION OF THE MEDIAL COLLATERAL LIGAMENT OF ELBOW

作　　者：蒋涛[1] 黄富国[2] 徐建华[1] 钟易林[1] 唐仁德[1] 

机构地区：[1]绵阳市第三人民医院,四川绵阳621000 [2]四川大学华西医院骨科

出　　处：《中国修复重建外科杂志》2008年第1期1-4,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的评价桡骨头切除、尺侧副韧带(medial collateral ligament,MCL)修复或重建手术治疗桡骨头粉碎性骨折合并MCL损伤的临床效果。方法2000年9月-2006年4月,对18例桡骨头粉碎性骨折合并MCL损伤患者,手术行桡骨头切除的同时,对MCL采用直接缝合修复或带蒂筋膜重建治疗。其中男12例,女6例;年龄21～57岁。跌扑伤或高处坠落伤10例,交通事故伤8例。骨折按Mason分类,Ⅲ型13例,Ⅳ型5例。15例于伤后2周内手术;3例陈旧损伤,分别于伤后4、6和14个月手术。手术修复MCL4例,重建MCL14例。结果术后18例均获随访1～5年,平均3年。根据Broberg等制定的肘关节功能评定标准,优4例,良12例,可1例,差1例,优良率为88.9%。3例肘部轻度疼痛,1例中度疼痛,14例无疼痛。肘关节伸屈活动范围110～140°,平均130°。前臂旋前35～85°,平均75°;前臂旋后65～89°,平均80°。患侧握力较健侧减少3%～28%,平均15%;伸肘力量减少8%～39%,平均30%;屈肘力量减少7%～29%,平均18%;旋前力量减少7%～31%,平均20%;旋后力量减少15%～45%,平均25%;患侧与健侧在相同外翻应力(外翻力矩2Nm)下X线片提携角增加0～11°,平均5°。以上指标患侧与健侧比较差异均有统计学意义(P<0.05)。结论MCL是抵抗肘关节外翻应力最主要的因素,在无条件行桡骨头假体置换时,行桡骨头切除、修复MCL是一种有效的手术方式,但远期效果仍需随访。Objective To evaluate the clinical effect of excising the radial head, repairing or reconstructing the medial collateral ligament （MCL） in treating comminuted fracture of the radial head accompanying by MCL injury. Methods From September 2000 to April 2006, 18 patients with comminuted fractures of radial head accompanying by MCL injury were treated by excision of the radial head, repair or reconstruction of the MCL. Of them, there were 12 males and 6 females, aged 21 to 57 years. Injury was caused by high falling in 10 cases and by traffic accidents in 8 cases. According to Mason classifications, 13 fractures were of type Ⅲ and 5 of type Ⅳ. Fifteen cases of fresh fractures were operated within 2 weeks, 3 cases of old fractures at 4, 6, and 14 months after injury respectively. Four cases underwent MCL repair and 14 cases underwent MCL reconstruction. Results All the 18 cases were followed up 1-5 years （mean 3 years ）. According to Broberg and Morrey scoring system, 4 patients were rated as excellent, 12 as good, 1 as fair, and 1 as poor. The excellent and good rate was 88.9%. Three patients had light pain of elbow, 1 patient had moderate pain and the other 14 had no pain. The range of elbow motion was from 110 to 140°（mean 130°）. The pronation averaged 75° （35-85°）. The supination averaged 80° （65-89°）. Compared with normal limbs, the grip strength decreased by 3% to 28% （mean 15%）; the extension strength decreased by 8% to 39% （mean 30%）; the flexion strength decreased by 7% to 29% （mean 18%）; the pronation strength decreased by 7% to 31% （mean 20%）; the supination strength decreased by 15% to 45% （mean 25%）. The X-ray films showed that carrying angle increased by 0 to 11° （mean 5° ） under two-newton-meter valgus torque. There were significant differences between injured limbs and normal limbs （P〈 0.05）. Conclusion The MCL was the primary valgus stabilizer of the elbow. If the radial head replacement could not be carried out, the repair or reconstructi

关 键 词：肘关节 桡骨头骨折 尺侧副韧带 修复重建 

分 类 号：R687.2[医药卫生—骨科学]