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肘关节内翻-后内侧旋转不稳定的诊断与治疗

Diagnosis and treatment of elbow varus posteromedial rotational instability

摘要:

目的 探讨肘关节内翻-后内侧旋转不稳定的诊断方法及疗效.方法 2009年11月至2011年4月共收治11例肘关节内翻-后内侧旋转不稳定患者,均为男性;年龄22 ~ 40岁,平均33.8岁.左侧4例,右侧7例;表现为肘关节内外侧均有压痛、肘关节轻度内翻、活动受限,但无肘关节脱位.术前应力像和三维CT检查,可见冠状突前内侧面骨折,肱桡关节间隙增宽.麻醉后于X线透视下检查,对前臂施加内翻、内旋及轴向应力,可诱发出明显的肘关节脱位和肱桡关节间隙增宽.患者均采用克氏针结合钢板螺丝钉固定冠状突骨折,并以铰链式外固定支架固定,均未修复侧副韧带.术后早期活动. 结果 11例患者术后获6~26个月(平均14.4个月)随访.平均屈曲为137.8°±4.4°(130°~ 140°),平均伸直为5.6°±7.3°(0~ 20°),平均屈伸为132 2°±9.7°(120°~ 140°);平均旋前为87.8°±6.7°(70°~90°),平均旋后为88.9°±3.3° (80°~ 90°),平均旋转为176.7°±10.0°(150°~180°).所有患者未出现肘关节不稳定、关节疼痛及肘内翻等并发症. 结论 手术治疗肘关节内翻-后内侧旋转不稳定,早期疗效满意,可避免保守治疗可能出现的肘内翻、关节快速退变及肘关节不稳定等并发症.

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abstracts:

Objective To report the early surgical outcomes of treating elbow varus posteromedial rotational instability (EVPRI),a pattern of traumatic elbow instability which has been recently described but incompletely understood. Methods From December 2009 to April 2011,11 male patients with an EVPRI pattern were surgically treated in our hospital.Their average age was 33.8 (from 22 to 40) years.They had 4 left and 7 right elbows affected.All had tenderness at the medial and lateral sides of the elbow and varus angulation of the elbow without dislocation.Their preoperative stress view X-rays and CT scans showed widened humeroradial joint space and fracture of the anteromedial facet of the coronoid process.We confirmed the diagnosis by applying yarus,pronated and axial stresses onto the forearm to evoke elbow dislocation,under fluoroscopy after anesthesia.In the initial operative treatment,the coronoid was repaired with a plate and K-wires applied to the medial surface of the coronoid,and a hinged external fixator was applied at the lateral side without repairing the lateral collateral ligament.Early rehabilitation was encouraged. Results All were followed up for an average of 14.4 (from 6 to 26) months.Each obtained an excellent result according to the Mayo Elbow Performance Index and recovered excellent elbow function.The average flexion was 137.8° ± 4.4° (from 130°to 140°), average extension 5.6°±7.3° (from 0 to 20°), average range of extension-flexion 132.2°±9.7° (from 120° to 140°),average pronation 87.8°±6.7° (from 70° to 90°),average supination 88.9° ± 3.3° (from 80° to 90°),and average range of rotation 176.7° ± 10.0° (from 150° to 180°).No complications such as varus subluxation of the elbow,infection and arthrosis occurred in this group. Conclusions Since EVPRI is a distinct type of elbow fracture-dislocation that must be recognized and adequately treated to restore good elbow function,inadequate or conservative treatment may cause subluxation,arthrosis or a poor outcome.Surgical treatment can achieve an excellent early outcome and avoid severe complications.

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