桡骨头骨折合并肘内侧副韧带前束损伤的临床解剖和功能研究  

The clinical anatomic and functional study of radial head fracture with anterior bundle of medial collateral ligament injury

作　　者：张磊[1] 何平平[2] 吕占辉[1] 张克民[1] 段晓东[1] 高广庭[1] 蔡长马[1] 

机构地区：[1]山东省滨州市中心医院骨关节外科,251700 [2]山东省滨州市中心医院临床药学办公室,251700

出　　处：《中国矫形外科杂志》2015年第2期106-113,共8页Orthopedic Journal of China

摘　　要：[目的]解剖学观察肘内侧副韧带前束（anterior bundle of medial collateral ligament,AMCL）损伤发生的部位、性质;探讨桡骨头骨折合并AMCL损伤对肘关节功能的影响及一期手术修复韧带疗效评价。[方法]2008年1月-2012年10月收治的桡骨头骨折合并AMCL损伤患者44例,男23例,女21例;年龄20-70岁,平均43.8岁,均为急性闭合性损伤,按照Mason分型Ⅱ型15例、Ⅲ型15例、Ⅳ型14例。按照分层随机分配方法分为对照组24例（AMCL损伤保守治疗）;观察组20例（AMCL损伤手术治疗）。对照组开放复位内固定桡骨头骨折后单纯行屈肘90°石膏托外固定3周;观察组一期手术行骨折开放复位内固定＋修复AMCL损伤,术后屈肘90°石膏托外固定制动3周。对两组患者治疗前行肘关节外翻应力X线片及MRI检查,并评估治疗前后HSS评分、提携角、关节间隙及肘关节各屈曲角度下偏离角度水平。[结果]全部病例获得随访,随访时间12-26个月,平均20.4个月。本研究中韧带损伤手术修复组20例患者,AMCL自内上髁止点撕脱15例（75%）、体部断裂4例（20%）、冠突止点断裂1例（5%）,其中AMCL自内上髁止点撕脱和体部断裂者占95%。两组患者治疗前肘关节外翻应力X线片内侧关节间隙、提携角比较、MRI冠状位SE序列T2加权像高信号率比较,差异均无统计学意义;两组患者末次随访肘关节外翻应力X线片内侧关节间隙、提携角、肘关节各屈曲角度下偏离角度水平比较,差异有统计学意义;两组患者治疗前肘关节HSS评分比较,差异无统计学意义,末次随访HSS评分比较,差异有统计学意义。[结论]（1）桡骨头骨折合并AMCL断裂部位多在肱骨内上髁附着处和体部,多为撕脱伤,可直接修复;（2）桡骨头骨折合并AMCL损伤可明显影响肘关节功能及稳定性。（3）AMCL损伤一期手术修复后可有效改善肘关节功能及稳定性。[Objective] To observe the position,extent,nature of anterior bundle of medial collateral ligament（ AMCL） injury,and to investigate the effects of radial head fracture with AMCL injury on elbow function and surgical repair ligament evaluation. [Method]Between January 2008 and October 2012,44 patients with radial head fracture combined with AMCL injury,including 23 males and 21 females,were enrolled in this study. Patients aged 20- 70 years,mean 43. 8 years. All cases were acute blunt trauma. According to Mason classification,15 cases were type II,15 cases were type III,14 cases were type Ⅳ. Stratified random allocation method was used to divided patients to a control group（ 24 cases,receiving conservative treatment,and observation group（ 20 cases,receiving surgical treatment）. Patients in the control group were treated with plaster immobilization under90 degrees elbow flexion for 3 weeks. Patients in the observation group were treated with surgical treatment and postoperative plaster immobilization under 90 degrees elbow flexion for 3 weeks. Elbow valgus stress was checked with X- ray and MRI in both 2 groups befor treatment. Elbow HSS score,carrying angle,joint space,and deviation angle on elbow flexion angle of each level were recorded befor and after treatment for statistical comparison. [Result]All patients were followed up for 12 to 26months（ average,20. 4 months）. In the observation group,AMCL from the medial epicondyle avulsion were in 15 cases（ 75%）,the body broken were in 4 cases（ 20%）,ulna coronoid avulsion was in 1 case（ 5%）. AMCL from the medial epicondyle avulsion fracture and the body broken accounted for 95%. There were no significant differences in bilateral comparison stress of theelbow joint space,carrying angle,MRI coronal T2- weighted SE sequences high signal rate between the contro group and the observation group before treatment,while significant differences was found in bilateral stress of the elbow joint space,carrying angle between 2 groups at final follow- up.

关 键 词：肘关节 桡骨头骨折 内侧副韧带前束 功能 

分 类 号：R687.3[医药卫生—骨科学] R322[医药卫生—外科学]