肘关节内翻-后内侧旋转不稳定的手术疗效分析  

Operative effect analysis of varus posteromedial rotatory instability of elbow joint

作　　者：殷照阳[1] 殷建 孙晓[1] 霍永峰[1] 盛路新[1] Yin Zhaoyang;Yin Jian;Sun Xiao;Huo Yongfeng;Sheng Luxin(Department of Orthopaedics,Lianyungang First People's Hospital,Lianyungang 222000,China;Department of Orthopaedics,the Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 211100,China)

机构地区：[1]连云港市第一人民医院骨科,222000 [2]南京医科大学附属江宁医院骨科,211100

出　　处：《中华肩肘外科电子杂志》2017年第3期173-179,共7页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：连云港市卫计委面上项目(201703);南京医科大学科技发展基金(2016NJMU156)

摘　　要：目的探讨创伤性肘关节内翻-后内侧旋转不稳定的术后疗效。方法 2011年6月至2015年12月连云港市第一人民医院收治创伤性肘关节内翻-后内侧旋转不稳定患者10例(10个肘),其中男6例、女4例,平均年龄34.8岁(20~67岁)。术后早期功能锻炼,采用Mayo肘关节功能评分系统(Mayo elbow performance score,MEPS)评价肘关节功能。定期复查X线片,采用Broberg和Morrey肘关节退行性关节炎X射线分级进行评价。结果所有患者肘关节骨折3个月后获得愈合,肘关节活动稳定,8例无疼痛症状,1例静止时偶有疼痛,1例活动时疼痛。肘关节活动伸直平均角度(29.6±11.4)°,屈曲平均角度(113.6±10.2)°,旋前平均(55.2±13.6)°,旋后平均(40.2±9.2)°。1例术后2个月开始出现骨化性肌炎,半年后予以手术松解,满足日常生活需要。根据MEPS评分结果优7例、良1例、中2例、差0例,优良率80%。结论肘关节内翻-后内侧旋转不稳定一期手术治疗至关重要,根据不同损伤类型制定个性化治疗方案有利于关节功能恢复。Background The varus-posteromedial instability of elbow joint refers to the injury characterized by fractures of the medial surface of coronoid process combined with fractures of coronal process,radial head or proximal ulna.The fractures are caused by the avulsion of lateral collateral ligament from the insertion of external humeral condyle and the impingement of the medial surface of ulnar coronoid process by distal humeral trochlea due to varus,posteromedial and axial stresses on elbow joint.This type of elbow injury is rare in clinic.The elbow joint dysfunction is commonly seen if treated improperly at the first stage.Unfortunately,the effect of orthomorphia at the second stage is rarely satisfactory.Hence,the first stage operation is critical.From June 2011 to December 2015,10 patients with traumatic varus-posteromedial ro tatory i nstability w ere t reated i n t he Fi rst Pe ople's Ho spital o f Li anyungang and obtained satisfactory results.Methods(1)General data.There were 10 patients(6 males and 4 females)in the group,and the average age was 34.8 years(20-67 years).The dominate elbow joint was affected for all cases,and no patient had previous history of elbow surgery.The causes of injury included 4 cases of bicycle fall,4 cases of traffic accident,1 case of high fall and 1 case of athletic injury.According to the O'Driscoll classification,there were 3 cases of type IIA fractures,4 cases of type IIB fractures and 3 cases of type IIC fractures.

关 键 词：肘关节 外科手术 骨折固定术 

分 类 号：R687.3[医药卫生—骨科学]