一种简易的肘关节旋转轴导针安置方法的可靠性研究  

A simple surgical method in determination of elbow rotation axis: a reliability study

作　　者：李宇能[1] 王驭恺 王开阳 王龑懋 关俊杰[2] 谭哲伦 葛宇峰 吴新宝[1] 占师 陆晟迪[2] 丁坚[2] LI Yuneng;WANG Yukai;WANG Kaiyang;WANG Yanmao;GUAN Junjie;TAN Zhelun;GE Yufeng;WU Xinbao;ZHAN Shi;LU Shengdi;DING Jian(Department of Orthopaedic Trauma,Beijing Jishuitan Hospital,Beijing 100035;Department of Orthopaedics,Shanghai Jiao Tong University Affiliated Sixth People's Hospital,Shanghai 200233,China)

机构地区：[1]北京积水潭医院创伤骨科,北京100035 [2]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《中华骨与关节外科杂志》2022年第7期518-523,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：目的:探讨一种简易的肘关节旋转轴导针安置方法的可靠性及其临床应用价值。方法:前瞻性选择2017年1月至2019年1月收治的需使用铰链式肘关节外固定支架的患者。应用简单随机化分组法分为高年资组和低年资组,分别由高年资(>3年)主治医师和低年资(≤3年)主治医师完成肘关节旋转轴导针置入。最终纳入43例患者,包括急性肘关节脱位11例,陈旧性骨折脱位7例,肘关节僵硬25例。其中高年资组22例,低年资组21例。术中记录肘关节旋转轴同心圆确认时间、透视次数、完成导针安置时间、术中肘关节无外力活动度。常规术后康复及随访,术后6周拆除外固定支架。记录末次随访时肘关节屈伸活动度及Mayo肘关节功能评分(MEPS)。结果:所有患者均完成术后随访,随访时间12~30个月,平均随访(16.4±5.7)个月。末次随访时,43例患者肘关节伸直活动度为0°~15°,平均(7.1±6.8)°;肘关节屈曲活动度为110°~140°,平均(122.9±22.0)°;MEPS评分为80~95分,平均(86.9±13.4)分。高年资组和低年资组定位肘关节旋转轴同心圆用时分别为(3.8±1.1)min、(5.0±1.4)min,差异有统计学意义(P<0.05);而两组透视次数、导针安置操作时间、术中支架安置后即刻肘关节活动度差异均无统计学意义(P>0.05)。末次随访时两组患者肘关节屈伸活动度及MEPS评分差异均无统计学意义(P>0.05)。结论:对于需要安装肘关节铰链式外固定支架的患者,固定C型臂X线机确定旋转轴的方法操作简单,可重复性强,学习曲线短,定位导针安置准确可靠,低年资医师也能较快掌握。Objective: To explore the reliability and clinical value of a simple method which is used to identify and place the elbow joint rotation axis guide wire. Methods: Patients treated with hinged external elbow fixator from January 2017 to January 2019 were enrolled in this prospective study. They were randomly divided into two groups: senior surgeons group(n=22, operated by senior surgeons) and junior surgeons group(n=21, operated by junior surgeons). There were 11 patients diagnosed as acute elbow dislocation,7 with chronic dislocation and 25 with elbow stiffness. The executive time for identification of concentric circle of humeral trochlea,fluoroscopic times, operation time and the range of motion of elbow were recorded. Postoperative rehabilitation and follow-up were taken routinely in these patients. The fixator was removed at 6 weeks after operation. At the last outpatient visit, the elbow extensionflexion range of motion was measured and Mayo elbow performance score(MEPS) was collected. Results: The mean follow-up time was(16.4±5.7) months(range, 12-30 months) in all the patients. At the final follow-up, the mean range of elbow extension was(7.1±6.8)°(range, 0°-15°), the mean range of elbow flexion was(122.9±22.0)°(range, 110°-140°), and the mean MEPS was(86.9±13.4)(range, 80-95). The executive time for identification of concentric circle of humeral trochlea was(3.8 ± 1.1) min in senior surgeons group and(5.0 ± 1.4) min in junior surgeons group(P<0.05). There was no significant difference in the rest of intraoperative measurements, such as fluoroscopic times, operation time or the range of motion of elbow between the two groups(P>0.05). Neither were the range of elbow flexion-extension nor MEPS at the final follow-up(P>0.05). Conclusions: For patients who require hinged elbow external fixator, the method of fixing the C-arm X-ray machine to determine the rotation axis is simple and repeatable. It has a short learning curve and the placement of elbow rotation axis guide wire is proved safe and reli

关 键 词：肘关节 旋转中心 铰链式外固定支架 透视 

分 类 号：R684[医药卫生—骨科学]