Essex-Lopresti损伤的诊断与治疗

目的探讨Essex-Lopresti损伤的诊断和治疗特点。方法对5例病人在确诊后行手术治疗,恢复或重建桡骨长度,同时复位并稳定下尺桡关节,并在术后对这5例病人进行了随访。结果术后所有病人的肘关节活动度均无严重受限,均无肘关节不稳定,除开放损伤的1例外其他均无疼痛和明显力量减弱。Morry肘关节评分平均为86．8分（75．5～95．5分）,其中优1例,良4例,可1例。病人的腕关节活动受限轻微,均没有明显的疼痛,1例病人在从事原来的重体力工作时略有力不从心,其他病人均能很好地恢复原来的工作。改良的Green＆O’Brien腕关节临床评分平均为87分（80—90分）,其中优3例,良2例。结论对于Essex—lopresti损伤,早期诊断非常重要。主要的治疗原则是恢复或重建桡骨长度的同时复位、稳定下尺桡关节。首要的是恢复或重建桡骨长度,在可能的情况下应尽量早期对桡骨头骨折进行切开复位内固定（ORIF）,如桡骨头骨折粉碎严重不能进行内固定,则可考虑一期进行人工金属桡骨头假体置换。对下尺桡关节损伤的处理应早期进行复位并对其进行一定的固定。

Diagnosis and treatment of Essex-Lopresti injury: report of five cases

OBJECTIVE: To explore the pathogenetic mechanism, diagnostic criteria, and treatment of Essex-Lopresti injury. METHODS: The clinical data of 5 patients with Essex-Lopresti injury that were treated by reconstruction of the length of radius, reduction and stabilization of the distal radio-ulnar joint and 3 of which were followed up were analyzed. RESULTS: In all the five patients there were no pain in elbow or wrist, instability in elbow joints, and limitation in the territory of the elbow joints. The patients had an average elbow score of 86.8 points (75.5 to 95.5 points), one with excellent result; 4 with good result, and one with fair result, according to the Morry's elbow joint scoring system. There was a little limitation for the wrist joints. The injuries did not affect their ordinary life. Only one of the 5 patients with open injury felt being unable to do as much as he would like to, and the others were capable to go back to work as usual. The average wrist score was 87 points (80 to 90 points), 3 with excellent result, and 2 with good result, according to the Green and O'Brien's wrist clinical scoring system. CONCLUSION: Early and accurate diagnosis is critical in order to obtain a satisfactory result in Essex-Lopresti injury. The primary goal is to reestablish the normal length of radius, relocation and stabilization of the distal radioulnar joint.