Essex-Lopresti损伤的诊治分析  

Characteristics and treatments of the Essex-Lopresti injury

作　　者：李明亮[1] 毛建水[1] 周崇斌[1] 王济纬[1] 叶志君[2] 

机构地区：[1]丽水市人民医院骨科,浙江丽水323000 [2]丽水市云和县人民医院,浙江丽水323600

出　　处：《中国骨伤》2017年第1期47-50,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的:总结Essex-Lopresti损伤的治疗经验,对比修复前臂骨间膜对近远期前臂功能的影响。方法:2005年1月至2013年12月收治24例Essex-Lopresti损伤患者,其中16例(A组)伴有尺骨干、桡骨干或尺桡骨干双骨折,先行尺骨或桡骨切开复位内固定,同时修复前臂骨间膜,然后再行桡骨小头复位固定和下尺桡关节固定或腕三角纤维复合体修复。8例(B组)不合并尺骨或桡骨骨折仅行桡骨小头复位固定和下尺桡关节固定或腕三角纤维复合体修复。分别于术后2周和2年按Cooney腕关节功能评分表(即改良Green和O’Brien腕关节评分)对腕关节功能进行评定,按Mayo肘关节功能评分表对肘关节功能进行评定。结果:术后2周时,腕关节功能评分A组可4例,差12例;B组可2例,差6例。肘关节评分A组良2例,可8例,差6例;B组良1例,可5例,差2例。术后2年时,A组腕关节功能评分良8例,可6例,差2例;B组良5例,可2例,差1例。肘关节评分A组良8例,可6例,差2例;B组良4例,可3例,差1例。两组术后2周和术后2年的疗效差异无统计学意义。结论:Essex-Lopresti损伤的治疗关键在于恢复尺桡骨的长度和腕、肘关节的动态稳定性,是否修复前臂骨间膜对前臂近远期功能影响无明显区别。Objective：To summarize experiences of operative treatment for Essex-Lopresti injury,and analyze the effect of the compare repair of interosseous membrane of forearm （IOM）on the forearm function. Methods：Twenty-four patients of Essex-Lopresti injury were treated from January 2005 to December 2013,16 patients （group A） with radius and/or ulna fractures were treated with open reduction and internal fixation of radius or ulna and repair of forearm bone membrane at the same time, and then treated with open reduction and internal fixation of head of radius, as well as lower ulnar joint fixation or repair of wrist triangle fiber complex. Another 8 patients without radius and or ulna fractures （group B） were treated with open reduction and internal fixation of head of radius ,as well as lower ulnar joint fixation or repair of wrist triangle fiber complex. The wrist joint function was evaluated using Cooney wrist functional rating index, and the elbow joint function was evaluated using Mayo elbow-performance score 2 weeks and 2 years after operation. Results：According to Cooney wrist functional rating index,4 patients in group A got a fair result and 12 poor,2 patients in group B got a fair result and 6 poor 2 weeks after operation; 8 patients in group A got a good result, 6 fair and 2 poor, 5 patients in group B got a good result, 2 fair and 1 poor 2 years after operation. According to Mayo elbow-performance score, 2 patients in group A got a good result, fair and 6 poor, 1 patient in group B got a good result, 5 fair and 2 poor 2 weeks after operation ; 8 patients in group A got a good result, 6 fair and 2 poor, 4 patients in group B got a good result, 3 fair and 1 poor. There were no statistically differences between two groups 2 weeks and 2 years after operation. Conclusion： It is important to restore the length of radius and/or ulna and maintain the dynamic stabilization of elbow and wrist for treat Essex-Lopresti injury. The repair of IOM has no effect on the forearm function.

关 键 词：ESSEX-LOPRESTI损伤 前臂骨间膜 下尺桡关节 病例对照研究 

分 类 号：R683.41[医药卫生—骨科学]