Essex-Lopresti损伤的手术治疗方法浅析  

SURGICAL TREATMENT OF Essex-Lopresti INJURY

作　　者：申友亮[1] 于腾波[1] 孙康[1] 刘金钊[1] 戚超[1] 

机构地区：[1]青岛大学医学院附属医院关节外科,山东青岛266003

出　　处：《中国修复重建外科杂志》2011年第11期1326-1329,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结切开复位内固定或人工桡骨头置换治疗Essex-Lopresti损伤的手术方法及疗效。方法2002年11月-2010年10月收治10例Essex-Lopresti损伤患者。男8例,女2例;年龄20～56岁,平均36岁。新鲜闭合骨折8例,受伤至手术时间1 h～2 d;桡骨头骨折按改良的Mason分型:Ⅱ型5例,Ⅲ型3例。余2例于外院行单纯桡骨头切除,因术后出现腕关节疼痛、前臂纵向不稳分别于伤后1个月和3个月入院。X线片示均有下尺桡关节脱位。桡骨头骨折采用切开复位微型钢板或可吸收螺钉内固定(5例)或人工桡骨头置换(5例)治疗,同时复位并固定下尺桡关节。结果患者术后切口均Ⅰ期愈合。10例均获随访,随访时间7～24个月,平均14.7个月。X线片示术后9～20周骨折均达临床愈合,平均16.3周;无桡骨近端移位,下尺桡关节稳定。术后6个月肘关节功能根据Morrey-Broberg功能评分系统评价获优5例,良3例,可2例;腕关节临床功能根据改良的腕关节临床评分系统评价获优7例,良2例,可1例。患者均无肘关节不稳,关节活动无严重受限;均恢复正常工作生活。结论早期诊断、尽早手术及术后早期功能锻炼对于Essex-Lopresti损伤的治疗尤为重要。Objective To summarize operative procedure and the effectiveness of open reduction with internal fixation or radial head replacement for the treatment of Essex-Lopresti injury.Methods Between November 2002 and October 2010,10 patients with Essex-Lopresti injury were treated.There were 8 males and 2 females with a mean age of 36 years（range,20-56 years）.Eight cases were fresh closed fracture within 2 days.According to Mason classification,5 fracture were type II,3 were type III.The other 2 cases were old fracture within 3 months.Wrist joint X-ray revealed that all the patients had distal radioulnar joint dislocation.Open reduction with internal mini-plate or absorbable screw fixation was performed in 5 cases,and radial head replacement in 5 cases;meanwhile,the distal radioulnar joint was reducted and fixed.Results All incisions healed by first intention without infection or bone nonunion.The patients were followed up 7 to 24 months with an average of 14.7 months.The X-ray films showed fracture healing at 9-20 weeks（mean,16.3 weeks）;distal radioulnar joint was stable without shortening or shift of proximal radius.According to elbow clinical evaluation system,the results were excellent in 5 cases,good in 3 cases,and fair in 2 cases.According to wrist clinical evaluation,the results were excellent in 7 cases,good in 2 cases,and fair in 1 case.All patients had good elbow stability,and recovered quickly.Conclusion Early diagnosis,operation,and functional exercises are important to obtain an excellent result in treating Essex-Lopresti injury.

关 键 词：ESSEX-LOPRESTI损伤 桡骨头骨折 下尺桡关节脱位 内固定 人工桡骨头置换 

分 类 号：R687.3[医药卫生—骨科学]