下尺桡脱位合并桡骨头脱位的诊断与治疗  

Diagnosis and treatment of simultaneous ipsilateral distal radioulnar joint dislocation associated with radial head dislocation

作　　者：李庭[1] 蒋协远[1] 刘亚波[1] 查晔军[1] 王满宜[1] 

机构地区：[1]北京积水潭医院创伤骨科,100035

出　　处：《中华关节外科杂志（电子版）》2011年第3期23-26,共4页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：北京市科技新星计划(项目编号2009B13)

摘　　要：目的探讨下尺桡脱位合并桡骨头脱位的的诊断和治疗。方法本文报道的2个典型病例,一例是下尺桡背侧脱位同时合并桡骨头后脱位,另一例是下尺桡掌侧脱位合并桡骨头前脱位,均不合并尺桡骨干的骨折。用单纯桡骨头脱位或下尺桡脱位的机制不能很好地解释。对于急性损伤,应先在麻醉下试行闭合复位,如不成功可考虑切开复位。结果根据目前研究,"绞锁损伤"的机制能比较好得解释这种损伤,骨间膜在前臂两骨之间起到一个"枢轴"的作用。早期诊断和治疗能达到良好的效果。结论早期诊断和早期复位固定非常重要,需要和孟氏骨折、盖氏骨折或Essex-lopresti损伤等相鉴别。Objective To describe two cases of simultaneous ipsilateral distal radioulnar joint （DRUJ） dislocation with radial head dislocation and review literatures, and to discuss the diagnosis and treatment. Methods Two typical cases were reported in this study. One suffered an injury of simultaneous ipsilateral dorsal dislocation of DRUJ and posterior dislocation of radial head. The other was ipsilateral volar dislocation of DRUJ and anterior dislocation of radial head. Both of them had no fracture in ulnar or radial shaft. The mechanism of isolated dislocation of DRUJ or radial head cannot explain this kind of injury. If possible, we should try close reduction of the dislocation under anaesthesia. After the close reduction failed, we performed open reduction and internal fixation. Results Until now, the mechanism of ＂crisscross＂ injury seems reasonable. The interosseous membrane may play a role and function as a pivot between the two forearm bones. Early diagnosis and early treatment is critical in order to obtain a satisfactory result. Conclusions This kind of injury should be differentiated from Monteggia or Galeazzi fractures, or Essex-Lopresti injury. Early diagnosis and early treatment are the most important.

关 键 词：骨间膜 前臂 脱位 

分 类 号：R684.7[医药卫生—骨科学]