尺骨鹰嘴影像学参数测量及临床意义

目的通过测量尺骨鹰嘴的影像学数据,为尺骨鹰嘴骨折张力带手术克氏针置入方向、角度及宽度提供理论参考。方法回顾性收集2020年9月至2020年12月我院60例成人正常肘关节正侧位X线片,其中男30例,女30例;男性平均年龄(37.63±13.75)岁,女性平均年龄(39.70±14.60)岁。分别测量并记录肘关节正位尺骨近端内翻角、鹰嘴最狭窄处宽度,肘关节侧位鹰嘴尖端过鹰嘴窝切线与尺骨轴线的夹角。结果尺骨近端内翻角男性平均为(10.71±2.77)°,女性平均(9.97±2.89)°,两组比较差异无统计学意义(P=0.70);男性鹰嘴最狭窄处宽度(1.90±0.96)mm,女性(1.61±0.12)mm,两组比较差异有统计学意义(P=0.00);鹰嘴尖端过鹰嘴窝切线与尺骨轴线的夹角男性平均(25.42±2.31)°,女性平均(23.12±2.64)°,两组比较差异无统计学意义(P=0.10)。结论通过测量的尺骨鹰嘴影像学参数,为鹰嘴骨折张力带手术时克氏针进针方向、角度及宽度提供参考,提高手术准确度。     

MRI、CT及DR在儿童肘关节细微骨折诊断中应用价值对比

目的 探讨MRI、CT与数字化X线摄影(DR)在儿童肘关节细微骨折中的诊断效能。方法 回顾性分析2019-05—2022-05河南省儿童医院收治的65例儿童肘关节细微骨折患儿的临床资料。所有患儿均施行MRI、CT与DR检查。结果 MRI共检出62例肘关节细微骨折，包括16例青枝型肱骨髁上骨折、10例外上髁骨骺损伤、13例内上髁骨骺损伤、7例桡骨小头骨折、7例尺骨冠状突骨折、5例尺骨鹰嘴骨折、4例尺骨近端骨折；CT共检出53例肘关节细微骨折，包括13例青枝型肱骨髁上骨折、8例外上髁骨骺损伤、11例内上髁骨骺损伤、5例桡骨小头骨折、6例尺骨冠状突骨折、6例尺骨鹰嘴骨折、4例尺骨近端骨折；DR共检出42例肘关节细微骨折，包括10例青枝型肱骨髁上骨折、7例外上髁骨骺损伤、10例内上髁骨骺损伤、4例桡骨小头骨折、4例尺骨冠状突骨折、5例尺骨鹰嘴骨折、2例尺骨近端骨折。MRI检查在肘关节细微骨折中的诊断符合率为95.38%,高于CT检查的81.54%、DR检查的64.62%;CT检查的诊断符合率高于DR检查。差异均有统计学意义(P<0.05)。结论 与CT及DR比较，MRI扫描对儿童肘关节细...     

尺骨鹰嘴骨折切开复位内固定术后肘关节僵硬相关危险因素分析

目的分析尺骨鹰嘴骨折切开复位内固定术后肘关节僵硬的相关危险因素。方法回顾性分析自2014-01—2019-01采用切开复位内固定治疗的240例尺骨鹰嘴骨折,32例术后肘关节屈伸运动范围≤100°或前臂旋转运动范围≤100°(僵硬组),208例术后肘关节屈伸运动范围>100°或前臂旋转运动范围>100°(非僵硬组)。分析性别、年龄、损伤侧别、损伤能量、受伤至手术时间、骨折Mayo分型、固定方式、是否使用CPM机、是否合并其他骨折与尺骨鹰嘴骨折切开复位内固定术后肘关节僵硬的相关性。结果单因素分析结果显示僵硬组与非僵硬组在损伤能量、骨折Mayo分型和固定方式方面比较差异有统计学意义(P<0.05),多因素Logistic回归分析结果显示高能量损伤、MayoⅢ型骨折是尺骨鹰嘴骨折术后肘关节僵硬的危险因素(P<0.05)。结论创伤性肘关节僵硬的发生常常是多因素综合作用的结果,高能量损伤和MayoⅢ型骨折为尺骨鹰嘴骨折切开复位内固定术后发生肘关节僵硬的独立危险因素。     

双微型锁定钢板治疗尺骨鹰嘴骨折的疗效观察

目的:探讨双微型锁定钢板治疗尺骨鹰嘴骨折的临床疗效。方法:自2017年3月至2020年5月,采用双微型锁定钢板治疗19例尺骨鹰嘴骨折患者,其中男12例,女7例;年龄20~75(40.50±7.62)岁;左侧10例,右侧9例。19例患者均为新鲜闭合骨折且不合并尺骨冠状突骨折、肘关节脱位等损伤。记录患者骨折愈合时间及并发症情况,并于术前、术后12个月采用Mayo肘关节功能评分标准(Mayo elbow performance score,MEPS)进行临床疗效评价。结果:19例患者术后均获得随访,时间12~17(13.51±3.17)个月。术后所有骨折获得骨性愈合,时间2~6(3.77±1.24)个月,未发生内固定断裂、螺钉松动、感染、内固定激惹、异位骨化、肘关节僵硬等并发症。术后12个月患侧肘关节MEPS评分(91.26±3.87)分与术前(56.18±9.56)分比较差异有统计学意义(P0.05);按照Mayo肘关节功能评分标准,结果优11例,良7例,中1例。结论:采用双微型锁定钢板治疗尺骨鹰嘴骨折,手术切口小,骨折固定可靠,术后可早期行肘关节功能锻炼,术后内固定对皮肤激惹小,肘关节功能恢复满意,是一种可靠的固定方法。     

克氏针钢丝张力带治疗合并尺骨鹰嘴骨折的肘关节脱位八例

合并尺骨鹰嘴骨折的肘关节脱位临床上比较少见。自1998年7月～2006年4月,笔者共收治8例合并尺骨鹰嘴骨折的肘关节脱位,报告如下。1临床资料1.1一般资料本组8例,男6例,女2例;年龄18～54岁,平均27岁。闭合性损伤3例,开放性损伤5例。致伤原因:高处坠落伤3例,钝器击伤2例,车祸伤2例     

肘关节侧方脱位2例报告

例1男,23岁,因车祸致右肘关节畸形,活动障碍伴环、小指电灼样麻木感。查体:右肘关节外翻畸形,屈肘位,肘后三角改变,鹰嘴在关节外侧扪及,鹰嘴窝空虚,右尺侧一个半指痛觉迟钝。X线片示:右肘关节外侧方脱位,尺骨鹰嘴冠状突卡于肱骨外髁侧方,桡骨小头完全脱位,伴内髁撕脱骨折,骨块在滑车下。 例2女,15岁,武术学校学生。做侧空翻时跌伤致左肘关节畸形,活动受限。查体:左肘关节呈前臂旋前屈曲外翻畸形,肘后三角改变,尺骨鹰嘴于外下方扪及,鹰嘴窝空虚。X线示:左肘关节外侧方脱位,桡骨小头卡于肱骨外上髁的侧方,尺骨鹰嘴脱于后外下方。 讨论 当上肢后伸,前臂旋前,肘关节屈曲,腕背伸     

肘髌骨1例

患者 ,男性 ,2 8岁。因碰伤右肘部致局部疼痛 1天就诊。查体 :右肘无畸形 ,右肘外侧软组织软度肿胀 ,局部压痛 ,肘后方可触及一约 3cm× 4cm大小骨块 ,椭圆形 ,表面光滑 ,无压痛 ,和尺骨鹰嘴之间可触及一约 3.5 cm间隙 ,肘关节伸屈活动正常 ,骨块随肘关节伸屈活动而上下移动。检查对侧无异常。侧位 X光片示 :离尺骨鹰嘴上方约 3.5 cm处有一 3.5 cm× 1.5 cm骨块 ,边缘光滑 ,尺骨鹰嘴无缺损。诊断右肘髌骨。未作特殊治疗 (如图 1)。讨　　论肘髌骨是由于尺骨鹰嘴骨骺持续分离而成 ,位于肱三头肌腱内 ,而 L evoine认为肘髌骨是肱三头肌腱内的…     

肘关节侧方脱位3例

肘关节侧方脱位临床少见,1993年6月～2000年3月我们收治3例,其损伤机制、临床体征和Ｘ线表现均有别于肘关节前后脱位类型。1　病例资料例1,男,23岁。因车祸致右肘关节畸形,活动障碍伴环、小指电灼样麻木感3ｈ。患者在驾驶摩托车时撞上围栏,导致人向侧前方摔出坠地,当时右肘呈半屈曲状,右手掌先着地,躯体着地之前曾感全部体重压于右手上,顿觉右肘部剧痛,伴有环、小指触电样麻木。查体:右肘关节外翻畸形,屈肘位,肘后三角改变,鹰嘴在关节外侧扪及,鹰嘴窝空虚,右尺侧一个半指痛觉迟钝。Ｘ线片示:右肘关节外侧脱位,尺骨鹰嘴、冠状突卡于肱骨外髁…     

钢板内固定结合外固定架治疗经尺骨鹰嘴肘关节骨折脱位7例

经尺骨鹰嘴肘关节骨折脱位属于复杂肘关节损伤的一种,包括肘关节前脱位、尺骨鹰嘴粉碎性或长斜形骨折以及冠状突骨折[1]。笔者自2008年2月~2011年11月共收治7例经尺骨鹰嘴肘关节复杂骨折脱位,采用切开复位钢板内固定联合同心铰链式外固定架外固定,疗效满意,报告如下。1临床资料1.1一般资料本组7例,男6例,女1例;平均39岁。车祸伤5例,高处坠落伤2例,伤后平均就诊时间为5 h。患者入院     

尺骨鹰嘴的影像学测量及其临床意义

目的使用影像学的方法测量成人尺骨鹰嘴相关参数,为术中尺骨鹰嘴骨折的复位及滑车切迹弧度的恢复提供参考依据。方法选取20例健康成年志愿者,拍摄左右两侧肘关节侧位片,使用PACS影像系统测量软件,测量男女尺骨鹰嘴宽度(a)、滑车切迹纵径(b)、鹰嘴深度(c)以及开口角(α)。结果男性尺骨鹰嘴宽度、滑车切迹纵径、鹰嘴深度均明显大于女性(P0.05)。上述参数男女性左右两侧的差异均无统计学意义(P>0.05)。结论利用影像学测量的方法,能精确测量尺骨鹰嘴的一些重要参数,可为术中尺骨鹰嘴骨折的复位及滑车切迹弧度的恢复提供参考依据。     

MRI诊断青少年运动员慢性肘关节运动损伤：成像序列的选择

目的探讨MRI诊断青少年运动员慢性肘关节损伤的价值以及成像序列的选择。方法以34名6-16岁运动员的40个肘关节作为研究对象,分别采用矢状位、冠状位及轴位MR扫描,分析图像特点。结果应用轴位T1W、矢状位T1W、T2W、STIR、PDW等序列明确显示肘关节软组织和骨骼解剖及其病变;矢状位T2W、STIR等序列能很好显示关节腔积液、骨膜增厚,PDW序列对骨质损伤、韧带受损及滑膜炎显示较好。结论 MRI可很好地显示青少年运动员慢性肘关节损伤的关节内、外骨骼肌肉组织受损情况;选择适当的成像序列是充分显示病变的基础。     

肱三头肌腱尺骨鹰嘴止点断裂的临床特征

目的 ：观察肱三头肌腱尺骨鹰嘴止点断裂的临床特征。方法 ：自2005年6月至2011年11月,共收治肱三头肌腱尺骨鹰嘴止点断裂19例,男7例,年龄15~41岁,平均24.1岁;女12例,年龄16~73岁,平均51.4岁。左侧8例,右侧11例。行走跌伤17例,高处坠落伤2例。单纯肱三头肌腱尺骨鹰嘴止点断裂13例,合并其他肘部损伤6例。合并桡骨头骨折5例,肱骨小头骨折1例,尺骨冠状突骨折1例,肱骨内上髁骨折1例。所有病例在肘关节侧位X线片上显示＂骨片征＂,合并伤有相应表现。均予手术治疗：＂8＂字钢丝固定15例,＂8＂字钢丝加克氏针固定1例,钢丝环扎固定1例,不吸收线缝合2例。合并伤予相应处理。除2例合并伤较重患者术后石膏固定4周,其余病例未行外固定。术后随访采用Mayo肘关节评分评价肘关节功能。结果：19例术后均获随访,1例术后1年死于其他疾病,其余18例随访时间14~91个月,平均47.9个月。Mayo肘关节评分优16例,良2例。结论：肱三头肌腱尺骨鹰嘴止点断裂临床上并不少见,好发于50岁以上女性和30以下男性,手术治疗效果良好,但合并有其他肘部损伤患者常遗留不同程度功能障碍。     

High-definition magnetic resonance images on medial elbow injuries in preadolescent Little Leaguers

BackgroundThe incidence of throwing-related elbow injuries is still rising. The study aimed to enhance the pathology of acute medial elbow injuries among young Little Leaguers by examining the medial elbows of symptomatic 9–10 years old Little Leaguers using High-Definition Magnetic Resonance Images (HDMRI), which uses a small-diameter surface coil on the target area, leading to greater image resolution.MethodWe identified Little Leaguers aged 9–10 years old. To minimize the detection of the chronic adaptative changes, players who experienced the medial elbow pain previously and whose HDMRI had not been taken within 4 weeks from the onset of medial elbow pain were excluded. This study considered 21 players, and the mean age was 9.4 ± 0.5 years.ResultThe fragmentation of the medial epicondyle apophysis via HDMRI was found in 15 elbows (71.4%), while the avulsion was seen in three cases. The signal hyperintensity at the medial epicondyle apophysis was observed in 2 cases. Our data showed abnormal changes to the medial epicondyle apophysis and surrounding structures, such as the ulnar collateral ligament (UCL), flexor-pronator tendons or the coronoid process of the ulna. We detected 11 abnormalities on X-ray imaging, while 20 subjects showed some abnormal findings via HDMRI.DiscussionThe current study showed that initial medial elbow injury in Little Leaguers without a history of previous elbow injury could be attributed to multi-structure injury. Over 90% of subjects were injured in the perichondrium, while 71.4% demonstrated a fragmentation of the secondary ossification center, and 14.3% experienced an avulsion of the medial epicondyle apophysis. Because the injuries were not limited to bony structures, HDMRI may be beneficial for the appropriate evaluation of medial elbow pain. The pathology of initial medial elbow injuries in young baseball players may be due to acute trauma instead of repetitive microtrauma.     

Is there something new regarding triceps brachii muscle insertion?

Purpose:Previous studies have questioned whether the triceps brachii muscle tendon (TBMT) has a double or single insertion on the ulna. Aiming to provide an answer, we describe the anatomy of the TBMT and review a magnetic resonance imaging (MRI) series of the elbow.Methods:Forty-one elbows were dissected to assess the details of the triceps brachii insertion. Elbow plastination slices were analyzed to determine whether there was a space on the TBMT. Magnetic resonance imaging from the records of the authors were also obtained to demonstrate the appearance of the pre-tricipital space on MRI.Results:A virtual space on the medial aspect near the TBTM insertion site in the olecranon was consistently found on anatomic dissections. It was a distal pre-tricipital space. Magnetic resonance imaging demonstrated the appearance of the pre-tricipital space on MRI, and its extension was measured longitudinally either in elbow flexion or extension. There was no statistically significant difference between the measurements of this space in the right and left elbows or between flexion and extension (p > 0.05). The coefficient of variation was <10% for all measurements.Conclusion:Knowledge of this structure may be essential to avoid incorrect diagnosis and unnecessary therapeutic interventions.Key words: Tendons, Muscles, Magnetic Resonance Imaging, Anatomy     

The usefulness of ultrasound and the posterior fat pad sign in pulled elbow

IntroductionA pulled elbow is a common cause of acute elbow pain that is generally managed by a reduction maneuver without radiographic examination. However, children with atypical presentation with no history of abrupt longitudinal traction should undergo elbow imaging. This study aimed to investigate plain radiography findings and determine the usefulness of ultrasonography (US) in atypical pulled elbow.Materials and methodsWe retrospectively reviewed the medical records and images of 37 (22 males) consecutive patients with pulled elbow who presented with an atypical history or failed reduction between April 2015 and September 2018. Mean age at presentation was 4.34 years (range, 1.25–9.5 years). Of the 37 elbows, 20 were left elbows. The injury mechanism, incidence of the posterior fat pad sign on plain radiographs, and characteristic US findings, pre- and post- reduction, were investigated.ResultsThe original mechanisms of injury included slipping (n = 14), rolling over the arm (n = 7), vague history (n = 6), falling down (n = 6), abrupt longitudinal traction (n = 2), and direct injury (n = 2). On plain radiographs, six of the 37 elbows (16%) showed the posterior fat pad sign. Before the reduction, an entrapped supinator, a pathognomonic sign of pulled elbow, was identified on US in all cases. After reduction, the characteristic US findings showed a disentangled and swollen supinator (100%) and restored annular ligament (100%) in all successful cases. Although a click was not felt in three cases, the reductions were considered successful because the annular ligament was restored on US with free elbow motion.ConclusionPulled elbow may be caused by atypical mechanisms of injury, such as slipping and rolling over the arm. Clinicians should be aware of the possibility of the posterior fat pad sign on plain radiographs of pulled elbow to prevent unnecessary immobilization. In such circumstances, US is a useful method for detecting an entrapped supinator and confirming adequate reduction via restoration of the annular ligament in children with atypical pulled elbow.     

Chondromalacia of trochlear notch after healing of olecranon stress fracture: a case report

Introduction: Chondromalacia of the trochlear notch and stress fracture of olecranon are uncommon injuries in the throwing athletes. Materials and methods: We report an 18-year-old high school pitcher who had persistent postero-lateral elbow pain after a healed olecranon stress fracture of the right elbow. Diagnostic arthroscopy revealed chondromalacia of the trochlear notch. Results: After treatment with arthroscopic drilling and abrasion chondroplasty, he returned to competitive pitching 1 year later postsurgery. This rare association between chondromalacia and stress fracture of the olecranon has not been reported previously in the literatures. Conclusion: Chondromalacia of the trochlear notch should be included as a differential diagnosis in evaluating athletes with persistent elbow pain after healed olecranon stress fractures.     

Magnetic resonance imaging findings in 46 elbows with a radial head fracture

Background and purpose Radial head fractures are common, and may be associated with other injuries of clinical importance. We present the results of a standard additional MRI scan for patients with a radial head fracture.

Patients and methods 44 patients (mean age 47 years) with 46 radial head fractures underwent MRI. 17 elbows had a Mason type-I fracture, 23 a Mason type-II fracture, and 6 elbows had a Mason type-III fracture.

Results Associated injuries were found in 35 elbows: 28 elbows had a lateral collateral ligament lesion, 18 had capitellar injury, 1 had a coronoid fracture, and 1 elbow had medial collateral ligament injury.

Interpretation The incidence of associated injuries with radial head fractures found with MRI was high. The clinical relevance should be investigated.     

重建冠状突治疗合并冠状突缺损的陈旧性肘关节脱位

目的 探讨重建冠状突治疗合并冠状突缺损的陈旧性肘关节脱位的可行性与疗效.方法 2008年7月至2010年1月共收治6例合并冠状突缺损的陈旧性肘关节脱位患者,均为男性,手术时平均年龄30.5岁(18～42岁);右侧4例,左侧2例.患者原始损伤均为肘部损伤"三联征",伤后平均手术次数1.2次(1～2次).均采用后侧切口行关节松解,松解后于肘关节伸肘位脱位,以自体鹰嘴尖或部分桡骨头重建冠状突,以螺钉或克氏针固定,并以Stryker铰链式外固定支架保护.术后第1天开始功能锻炼,并口服吲哚美辛预防异位骨化,外固定支架于术后8周去除.结果 6例患者皆获得较好的术中稳定性,重建冠状突后,伸肘位肘关节无明显后脱位趋势.术后平均随访12个月(3～21个月).肘关节屈伸活动度由术前平均13.3°(0～35°)改善为术后120.0°(100°～140°),前臂旋转活动度由术前平均62.5°(10°～140°)改善为术后141.7°(110°～170°),Mayo肘关节功能评分由术前平均51.7分(50～55分)改善为术后97.5分(85～100分).结论 以自体鹰嘴尖或部分桡骨头重建冠状突可显著增加合并冠状突缺损的肘关节稳定性,是治疗合并冠状突缺损的陈旧性肘关节脱位的一种较好方法.     

雪橇板技术治疗尺骨鹰嘴骨折的临床观察

目的:探讨鹰嘴雪橇板固定技术治疗尺骨鹰嘴骨折的临床疗效。方法:2017年3月采用鹰嘴雪橇板固定技术治疗4例尺骨鹰嘴骨折患者,其中男2例,女2例;年龄40,46,47,72岁;左侧3例,右侧1例;均为摔伤引起。骨折均为横行、斜行或轻度关节面压缩骨折。伤后1～3 d内进行手术。观察患者的手术时间、术中出血量、并发症及术后肘关节屈伸和前臂功能恢复情况,采用VAS评分评价疼痛缓解程度,并采用Mayo肘关节功能评分评价肘关节功能恢复情况。结果:至2018年9月,4例获得随访,时间18个月。手术时间40～60 min,术中出血量20～40 ml,术后无切口并发症。所有患者术后4个月随访时骨折愈合。末次随访时屈肘140°～150°,伸肘0°～过伸10°,屈伸活动范围140°～160°,MEPS评分为100分。患者活动时无明显疼痛感,VAS评分为0分。结论:鹰嘴雪橇板的低切迹设计和一体化设计避免了张力带和钢板常见的内固定物激惹现象,操作简单,对于简单和轻度粉碎的鹰嘴骨折是一种理想的内固定方式,但不适用于严重粉碎的鹰嘴骨折。     

Ulnar neuropathy at the elbow in 413 Japanese patients: An assessment of pathological elbow lesions and neurological severity

BackgroundVarious pathological elbow lesions are often complicated with ulnar neuropathy at the elbow (UNE), although the precise pathology, incidence, and clinical and neurological features of these lesions have not been identified. We therefore investigated elbow pathology and neurological severity in Japanese patients with UNE.MethodsThe medical records of 457 Japanese UNE patients who were surgically treated among 6 hospitals were retrospectively examined. Eligible patients had UNE diagnosed by physical findings and nerve conduction studies according to the criteria of the American Association of Electrodiagnostic Medicine. The elbows were analyzed with regard to age, gender, occupation, pathology at the elbow, and severity of nerve palsy.ResultsA total of 398 patients with 413 UNE elbows of a mean age of 63 years (range: 15–87) met the inclusion criteria. UNE elbows were predominantly in male patients (69.0%). Overall, 310 elbows (75.1%) had 1 or more elbow lesions: 238 elbows (76.8%) had a single lesion and 72 elbows (23.3%) had 2 or more lesions. The most common lesion was primary elbow osteoarthritis (EOA) occurring in 54.5% of elbows, followed next by medial elbow ganglion in 8.5% and cubitus valgus in 6.5%. Most elbows with medial elbow ganglion or cubitus valgus were associated with EOA. Entrapment sites were at the cubital tunnel in 84.5%–91.3% of UNE elbows, regardless of an association with elbow lesion. The incidence of McGowan grade III lesion was 50.8% in elbows with primary EOA, which was higher than the 35.0% in elbows with no lesion.ConclusionsThis study revealed that UNE had various isolated or combined elbow lesions. In Japanese UNE, primary or secondary EOA was found in 62.2% of cases and severe motor weakness was noted in 47.2%. The incidences of EOA and severe ulnar nerve palsy in the Japanese UNE are higher than those in Caucasians.Level of evidenceLevel IV; Prognostic—Investigating the effect of a patient characteristic on the outcome of a disease; Case series.