桡骨头假体置换并复位稳定下尺桡关节治疗陈旧Essex-Lopresti损伤
Radial head replacement with metal prosthesis and reduction with stabilization of the distal radio-ulnar joint as a treatment of established Essex-Lopresti injury
目的 探讨采用金属桡骨头假体置换并复位稳定下尺桡关节治疗陈旧Essex-Lopresti损伤的效果.方法 回顾性分析2012年3月至2015年12月收治的5例桡骨头切除术后2个月以上Essex-Lopresti损伤患者资料.其中男4例,女1例;年龄25~50岁,平均38.8岁;从初次手术至再手术时间间隔2~7个月,平均4.6个月.5例患者均行金属桡骨头假体置换恢复桡骨的纵向稳定,而后复位并稳定下尺桡关节;其中4例行尺骨远端截骨短缩匹配下尺桡关节.5例患者中2例复位下尺桡关节后稳定;其余3例复位下尺桡关节后仍不稳,行切开缝合修复背侧韧带结构并横向穿针固定4~6周.术前及末次随访时均记录肘关节(屈、伸)、前臂(旋前、旋后)和腕关节(屈、伸、尺偏、桡偏)的活动范围,采用Mayo肘关节功能评分及Mayo腕关节功能评分进行评定,记录手术并发症.结果 5例患者均获得完整随访,随访时间24~60个月,平均45个月.Mayo肘关节功能评分,术前45~75分,平均62分;末次随访时80~100分,平均96分;Mayo腕关节功能评分,术前15~65分,平均54分;末次随访时55~90分,平均81分.术后无一例出现桡骨向近端移位、桡骨头假体失效、下尺桡关节不稳定等情况,术后上肢功能得到明显改善.结论 采用金属桡骨头假体置换并复位稳定下尺桡关节,必要时行尺骨远端截骨短缩匹配下尺桡关节是治疗陈旧Essex-Lopresti损伤的有效方法.
更多Objective To investigate the effect of radial head replacement with metal prosthesis and reduction with stabilization of the distal radio-ulnar joint as a treatment of established Essex-Lopresti injury.Methods From March 2012 to December 2015,5 patients with established Essex-Lopresti injury,whose radiuses had moved proximally since radial head had been resected in the earlier operation,were operated in our department,including 4 males and 1 female,aged from 25 to 50 years (average,38.8 years).The interval from the radial head resection to the operation in our department was 2 to 7 months (average,4.6 months).All the 5 patients were operated with radial head replacement with metal prosthesis under no longitudinal stress,and 4 of them got distal ulnar shortening for reduction of the distal radio-ulnar joint.2 of the 5 cases acquired distal radial-ulnar joint stability after reduction,and the other 3 could not acquired stability and needed open reduction and repairing ligament structure of the wrist and pinning fixation for 4-6 weeks.The Mayo elbow and wrist function score were used to evaluate pre-and post-operative function,with recording the range of motion of the elbow,forearm and wrist.Results All the 5 patients were followed-up for 24 to 60 months (average 45 months).The Mayo elbow function score was improved from preoperative 62 (range,45-75) to 96 (range,80-100) at the latest follow-up.The Mayo wrist functional score was improved from 54 (range,15-65) to 81 (range,55-90) at the latest follow-up.All patients got significant improvement of involved upper extremity function,without proximal shifting of radius,radial head prosthesis failure or instability of the distal radio-ulnar joint.Conclusion It is effective for treatment of established Essex-Lopresti injury to replace radial head with metal prosthesis and to reduce and stabilize the distal radio-ulnar joint with distal ulnar shortening while necessary.
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