肘关节后内侧脱位的临床研究  

A clinical study of posterior-medial dislocation of elbow joint

作　　者：李绍良[1] 鲁谊[2] 王满宜[1] 东靖明[3] Li Shaoliang;Lu Yi;Wang Manyi;Dong Jingming(Department of Orthopaedic Trauma,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Sports Medicine,Beijing Jishuitan Hospital,Beijing 100035,China;Department of No.2 Upper Extremity Traumatology,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]北京积水潭医院创伤骨科,北京100035 [2]北京积水潭医院运动损伤科,北京100035 [3]天津市天津医院创伤上肢二病区,天津300211

出　　处：《中华骨科杂志》2022年第4期244-250,共7页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金 (82172512)。

摘　　要：目的探讨肘关节后内侧脱位的临床特征和治疗效果。方法回顾性分析2014年1月至2016年3月收治的15例肘关节后内侧脱位患者资料,其中男12例,女3例;平均年龄44岁(范围23~64岁)。1例为单纯脱位,余14例为合并骨折的复杂性脱位。分析发现肘关节后内侧脱位的特征性表现为肘关节的携物角改变或肘关节内翻畸形,8例患者肘关节外侧有明显的"凹陷征"。1例单纯性脱位和1例复杂性脱位采用非手术治疗,余13例复杂性脱位接受手术治疗,其中5例因肘关节不稳定以铰链式外固定架固定。记录治疗前及末次随访时的肘关节活动范围、疼痛视觉模拟评分(visual analogue scale,VAS)及梅奥肘关节功能评分(Mayo elbow performance score,MEPS)。结果15例患者随访时间平均为18个月(范围17~21个月)。15例治疗前伸屈活动为9.3°±1.3°(范围5°~15°),旋前6.4°±1.4°(范围0°~10°),旋后4.3°±1.7°(范围0°~10°);VAS评分(8±0.3)分(范围7~9分);MEPS评分(15.7±4.3)分(范围5~35分)。末次随访时15例伸屈活动为105°±5.2°(范围90°~130°),旋前60°±8.5°(范围20°~80°),旋后76°±9.5°(范围20°~90°);VAS评分(0.4±0.2)分(范围0~1分);MEPS评分(95.7±2.3)分(范围85~100分)。所有观察指标经自身配对样本t检验显示治疗前后的差异均有统计学意义(P<0.001)。所有患者治疗后定期随访时影像学检查及体检均未发现不稳定。结论肘关节后内侧脱位是一种较为少见的肘关节损伤,单纯的肘关节后内侧脱位闭合复位通常可以成功;复杂肘关节后内侧脱位多数需要手术治疗,其临床治疗效果较为满意。Objective To analyze the clinical characters and results of the posteromedial dislocation of elbow.Methods From January 2014 to March 2016,a retrospective observational study of 15 patients with posteromedial elbow dislocations was performed.There were twelve males and three females,the mean age was 44 years old(23-64 years old).There were fourteen complex dislocations and one simple dislocation.The signs of posteromedial dislocation included changes of carry angle and varus deformity.Dimple signs were found in 8 patients.Conservative treatment was used in two cases(one simple dislocation and one complex disclocation).Operative treatment was performed in the other 13 cases with complex dislocations,in which five were fixed by hinged external fixator due to instability.The ranges of elbow and forearm movement,visual analogue score(VAS)and Mayo elbow performance score(MEPS)were recorded before treatment and at the last visit after average 18 months(17-21 months)of follow-up.Results Before treatment,the average arc of extension-flexion was 9.3°±1.3°(5°-15°),the average range of forearm pronation was 6.4°±1.4°(0°-10°),supination was 4.3°±1.7°(0°-10°);VAS averaged 8±0.3 scores(7-9 scores);MEPS averaged 15.7±4.3 scores(5-35 scores).At the last follow up,the average arc of extension-flexion was 105°±5.2°(90°-130°),the average range of forearm pronation was 60°±8.5°(20°-80°),supination was 76°±9.5°(20°-90°);VAS averaged 0.4±0.2 scores(0-1 score);MEPS averaged 95.7±2.3 scores(85-100 scores).Significant different was found in all index by paired t test(P<0.001).No instability of elbow was found in physical and radiology test in all follow-up visit.Conclusion Posteromedial dislocation of elbow is rare in clinics,closed reduction can be always successful in simple dislocations;open reduction would be necessary in the majority of complex dislocations.However,relatively satisfied clinical results could be achieved.

关 键 词：肘关节 脱位 活动范围 关节 治疗结果 

分 类 号：R684.7[医药卫生—骨科学]