桡骨远端骨折合并同侧肘关节脱位的损伤机制及手术治疗

目的 探讨桡骨远端骨折合并同侧肘关节脱位的损伤机制和手术方法.方法 2007年12月至2011年4月我院共收治桡骨远端骨折合并同侧肘关节脱位损伤7例.桡骨远端骨折按AO/ASIF分型标准确定:A3型3例,C1型2例,C3型2例.均为肘关节后脱位,其中2例合并有冠状突尖部骨折,为Regan-Morrey分型中的工型.2例合并有前臂筋膜室间隔综合征早期表现.6例行肘关节侧副韧带修复,桡骨远端骨折均行骨折切开复位内固定术,2例经皮下行前臂深筋膜切开减压.结果 术后平均随访时间为16.4个月(9～26个月),无再骨折或脱位,无伤口感染,2例前臂远端伤口二期缝合.7例桡骨远端骨折均在术后6个月内愈合,肘关节稳定,2例肘关节周围出现少量的异位骨化,但不影响肘关节活动.Cooney腕关节评分平均为89.5分(75～100分),其中优2例、良3例、中1例、差1例.Mayo肘关节功能评分平均为90.5分(75～ 100分),其中优4例、良2例、中1例.肩臂手残障问卷表评分(DASH)为5分(2～ 11分).结论 桡骨远端骨折合并同侧肘关节脱位多为高能量损伤,损伤机制为腕关节背伸位,肘关节伸直位,整个上肢受到外翻、旋后和轴向的应力.较易引起前臂筋膜室间隔综合征,通过手术修复损伤的肘关节周围韧带和复位固定桡骨远端骨折可获得良好效果.     

尺骨近端粉碎性骨折伴肘关节不稳定的治疗

目的 探讨尺骨近端粉碎性骨折伴肘关节不稳定的治疗方法及疗效.方法 尺骨近端粉碎性骨折伴肘关节不稳定患者33例,男23例,女10例;年龄21～61岁,平均41.3岁.11例合并桡骨头骨折,15例合并尺骨冠突骨折,7例同时合并桡骨头及尺骨冠突骨折.采用钢板螺钉内固定治疗,其中一期植骨9例.合并桡骨头骨折患者,如骨折粉碎不严重,复位后用克氏针固定,并修补环状韧带;如骨折粉碎严重,则行人工桡骨头置换,同时取自体掌长肌腱重建环状韧带.合并尺骨冠突骨折患者,12例Ⅱ、Ⅲ型骨折患者,选用克氏针或拉力螺钉固定骨折块,同时探查尺侧副韧带前束,如损伤予以修复或重建;4例Ⅳ型骨折患者,取自体骨重建冠突,取自体掌长肌腱重建尺侧副韧带前束.结果 患者伤口均一期愈合,骨折愈合率为100%.术后随访8～36个月,平均22个月.3例有创伤性关节炎表现,4例发生轻度创伤性骨化.肘关节平均屈伸范围为112°±24°,前臂平均旋转活动范围为108°±27°.按照Morrey等肘关节功能评定标准进行评价:优10例,良14例,可7例,差2例,总优良率为72.7%.结论 治疗尺骨近端粉碎性骨折伴肘关节不稳可采用钢板螺钉固定尺骨近端骨折,必要时行一期植骨,注意对桡骨头、尺骨冠突骨折及肘关节侧副韧带损伤的治疗,以防止肘关节不稳定.     

可吸收缝线辅助固定治疗肘关节软骨骨折

目的报告可吸收缝线辅助缝合固定治疗肘关节软骨骨折的临床疗效。方法回顾性分析自2016年6月至2021年3月收治的21例肘关节软骨骨折患者的临床资料, 其中肘关节脱位伴肱骨内髁骨折桡骨小头骨折1例, 桡骨小头骨折伴软骨部分游离6例, 桡骨小头骨折伴肱骨小头骨折6例, 肱骨远端关节内骨折3例, 肘关节脱位伴桡骨小头尺骨冠突骨折4例, 尺骨鹰嘴桡骨小头尺骨冠突骨折1例。所有患者均在术中使用可吸收缝线进行缝合辅助固定关节软骨骨折块。术后根据Broberg-Morrey肘关节功能评分标准评价肘关节功能, 记录肘关节的屈伸活动度及前臂旋转活动度。结果术后所有患者均获得随访, 时间为13～64个月, 平均23个月。1例因关节周围异位骨化形成二期行关节松解手术;1例内侧副韧带钙化, 肘关节僵硬。末次随访时患侧肘关节平均屈曲119.8°(90°～140°), 伸直-3.8°(-45°～0°);前臂旋前78.3°(46°～84°), 旋后79.6°(62°～87°)。肘关节Broberg-Morrey评分为59～95分, 平均91.2分;优12例, 良8例, 差1例。结论通过缝合固定技术修复肘关节软骨骨折...     

累及桡尺远侧关节不稳定的尺骨茎突骨折手术治疗

目的 介绍累及桡尺远侧关节不稳定的桡骨远端合并尺骨茎突骨折的手术指征和治疗方法.方法 2005年1月至2009年6月,对12例桡骨远端骨折合并尺骨茎突骨折的患者,采用克氏针结合张力带钢丝固定尺骨茎突,同时采用骨锚修复下尺桡韧带深层结构在尺骨隐窝的止点,从而稳定桡尺远侧关节.结果 术后12例桡骨远端骨折及尺骨茎突骨折均愈合,术后随访时间为6～18个月.按改良的Mayo腕关节评分标准评定:优4例,良5例,中2例,差1例.结论 尺骨茎突在桡尺远侧关节稳定中起着重要作用,对累及下尺桡韧带结构损伤的尺骨茎突骨折进行固定并重建韧带对稳定桡尺远侧关节有较为重要的作用.     

肘关节恐怖三联征的诊治

肘关节脱位可以分为简单型和复杂型两种。简单型脱位仅有关节囊和韧带的损伤,而复杂型脱位常合并有肘关节周围的骨折。1996年Hotchkiss首先将肘关节后脱位合并尺骨冠状突和桡骨头骨折的这种复杂型脱位命名为“terribletriedinjuriesoftheelbow”,国内学者大多将其翻译为“肘关节恐怖三联征”。2005年Armstrong重新定义为肱尺关节后脱位合并尺骨冠状突骨折、桡骨头骨折及外侧副韧带损伤,伴或不伴有内侧副韧带、屈肌一旋前圆肌止点、伸肌总腱、肱骨头及尺骨滑车切迹等骨与软组织损伤。肘关节恐怖三联征可以引起肘关节僵硬、创伤性关节炎、异位骨化等各种并发症,因此,这种损伤越来越受到广大创伤学者的关注。本文将对肘关节恐怖三联征的诊治进行综述。     

尺骨鹰嘴截骨入路内固定联合肘关节功能支具治疗肱骨远端粉碎性骨折

目的探讨尺骨鹰嘴截骨入路内固定联合肘关节功能支具治疗肱骨远端粉碎性骨折的疗效。方法回顾性分析自2009-05—2015-12采用尺骨鹰嘴截骨入路内外侧垂直钢板内固定治疗AO-C型肱骨远端骨折22例,术后肘关节功能支具功能位固定并功能锻炼。结果本组手术时间60~85 min,平均70 min;术中出血量100~300 ml,平均130 ml。21例获得随访0.5~2.5年,平均1年。骨折愈合良好,1例未行尺神经前移导致小指麻木,经前移手术后麻木消失。末次随访时肘关节活动度:伸0°~15°,屈110°~140°,前臂旋前60°~75°,旋后70°~85°;肘关节功能Mayo评分80~90分,其中优13例,良6例,可1例,差1例,优良率90.5%。结论经尺骨鹰嘴截骨入路内外侧垂直钢板内固定治疗肱骨远端粉碎性骨折关节面显露充分,骨折复位及内固定置入方便,术后肘关节功能支具固定可早期功能锻炼,肘关节功能恢复良好。     

肘关节"恐怖三联征"合并尺骨鹰嘴骨折的手术治疗

目的 介绍肘关节"恐怖三联征"合并尺骨鹰嘴骨折的手术方法和疗效.方法 肘关节"恐怖三联征"合并尺骨鹰嘴骨折患者12例,男8例,女4例;年龄21~75岁,平均40.4岁.桡骨头骨折按Mason分型:Ⅱ型7例,Ⅲ型5例;因合并肘关节脱位,按Johnston-Mason分型均为Ⅳ型.冠突骨折按Regan-Morrey分型:Ⅰ型2例,Ⅱ型4例,Ⅲ型6例.尺骨鹰嘴骨折按Mayo分型Ⅱa型2例,Ⅱb型2例,Ⅲa型2例,Ⅲb型6例.9例肘关节后脱位,3例为前脱位.12例均行手术治疗,冠突、鹰嘴骨折行内固定;桡骨头骨折行内固定、桡骨头切除、金属桡骨头置换,修复内、外侧副韧带.术后石膏托维持肘关节屈曲90°,前臂中立位固定3周.结果 8例(66.7%)患者获得随访,随访时间3~36个月.平均16.4个月.骨折全部愈合,愈合时间10~16周,平均14.2周.Broberg-Morrey评分为55~95分,平均88分,优4例,良2例,可1例,差1例,优良率为75.0%.肘关节屈伸范围为70°~150°,平均127.5°;前臂旋转范围为65°~155°,平均122.5°.结论 肘关节"恐怖三联征"合并尺骨鹰嘴骨折为高能量损伤,关节严重不稳定,必须重建骨关节及软组织的解剖结构,恢复肘关节稳定性.     

改良肘关节前内侧入路治疗尺骨冠状突骨折

目的探讨改良肘关节前内侧入路治疗尺骨冠状突骨折的临床疗效。方法 2010年1月—2014年12月,采用改良肘关节前内侧入路治疗13例尺骨冠状突骨折患者。其中,男10例,女3例;年龄18~57岁,平均37.2岁。致伤原因:交通事故伤5例,高处坠落伤7例,硬物撞击伤1例。损伤类型:肘关节恐怖三联征7例,冠状突骨折合并同侧桡骨头骨折4例,尺、桡骨近端关节内粉碎双骨折1例,冠状突骨折合并同侧桡骨远端骨折1例。尺骨冠状突骨折按照Regan-Morrey分型:Ⅱ型2例,Ⅲ型11例;按照O’Driscoll分型:冠状突前内侧面骨折10例(Ⅱb型8例、Ⅱc型2例),基底部骨折3例。记录尺骨冠状突骨折复位内固定手术时间、术中出血量以及相关并发症发生情况。通过X线片及临床检查判断骨折是否愈合,记录愈合时间。测量肘关节屈伸、旋转活动度,根据Mayo肘关节功能指数(MEPI)评价肘关节功能。结果手术时间为30~55 min,平均38.7 min;术中出血量为90~160 mL,平均109.3 mL。术后切口均Ⅰ期愈合,无医源性血管、神经损伤发生。患者均获随访,随访时间13~24个月,平均16.9个月。骨折均达临床愈合,愈合时间8~16周,平均11.2周;2例异位骨化形成。末次随访,肘关节活动度屈119~145°,平均132.4°;伸–8~15°,平均7°;前臂旋前68~90°,平均78.6°;旋后76~90°,平均84.3°。MEPI为70~100分;其中优9例,良3例,可1例,优良率92.3%。结论改良肘关节前内侧入路治疗尺骨冠状突骨折,可以避开肘部重要血管、神经,直视下进行骨折块复位、固定,是一种安全、简便、有效的手术入路。     

前后联合入路治疗儿童陈旧性孟氏骨折

[目的]探讨前后联合入路行关节切开复位、尺骨截骨术治疗儿童陈旧性孟氏骨折的方法及疗效。[方法]回顾性分析2010年11月~2015年1月收治的22例陈旧性孟氏骨折患儿资料。男15例,女7例,平均年龄7.5岁。伤后至手术时间除2例分别为3年、5年外,其余20例为1~12个月。患者X线片示桡骨头脱位,尺骨桡侧或掌侧弓形弯曲,伤后时间长者见桡骨过度生长。2例伴有桡神经深支损伤症状。所有患儿均采用经肘前Henry入路行肱桡关节切开、瘢痕彻底清除,有桡神经损伤者同时行神经探查松解;肘后沿尺骨嵴做纵切口,在尺骨鹰嘴下4~5 cm横行截骨,矫正尺骨畸形并反向成角、截骨端延长后予钢板固定。所有患儿均不行环状韧带重建。[结果]本组患儿随访12~59个月,平均15.4个月。根据Mackay功能评定标准,优19例,良2例,差1例。X线片示1例再脱位、2例半脱位,余复位稳定。术后肘关节屈伸功能较术前改善,差异具有统计学意义(P<0.05);手术前后前臂旋转功能的差别无统计学意义(P>0.05)。未出现血管神经损伤、异位骨化、尺桡骨骨性连接等并发症。2例桡神经深支损伤患儿3个月内恢复正常。[结论]前后联合入路治疗儿童陈旧性孟氏骨折具有术野显露好、术中操作简便、术后并发症少等优势。前入路允许直视下处理关节内病理改变,同时便于行桡神经探查松解,后入路有利于尺骨截骨矫形术。     

外固定架联合克氏针固定治疗不稳定桡骨远端骨折合并尺骨远端骨折疗效观察

目的探讨采用外固定架联合克氏针固定治疗不稳定桡骨远端骨折合并尺骨远端骨折的临床疗效。方法回顾性分析自2015-07—2016-10采用外固定架联合克氏针固定治疗的28例不稳定桡骨远端骨折合并尺骨远端骨折。末次随访时进行腕关节功能Gartland-Werley评分、PRWE评分并评价患者满意度。结果 28例均获得随访,随访时间平均9.2(8~10)个月。骨折均愈合,愈合时间平均3.3(3~5)个月。末次随访时桡骨均无短缩,掌倾角平均5.3°(0°~8°),尺偏角平均23.3°(21°~27°)。末次随访时腕关节功能Gartland-Werley评分:优14例,良10例,可4例,优良率85.7%;PRWE评分平均28.3(15~41)分。结论对于不稳定桡骨远端骨折合并尺骨远端骨折,应充分认识到尺骨远端解剖结构的重要性,采用外固定架固定治疗时可以联合横向克氏针固定以稳定下尺桡关节,获得更满意的疗效。     

Complex elbow dislocation associated with radial and ulnar diaphyseal fractures: a rare combination

We illustrate a rare complex dislocation of the elbow involving a posterior ulno-humeral dislocation associated with open diaphyseal fracture of the ulna, radial shaft fracture, Type 1 coronoid fracture and neuropraxia of the deep branch of the radial nerve. The isolated ulno-humeral dislocation without radio-capitellar involvement, and ulnar diaphyseal fracture, makes this “reverse Monteggia” type of injury pattern very unique. This patient was managed with an initial reduction of his ulno-humeral joint and stabilization of his radius and ulna fractures. He underwent a delayed medial collateral ligament reconstruction a few days later. His fractures went on to unite fully, his elbow joint remained stable, and he achieved good range of motion of his elbow.     

A Galeazzi-variant type fracture-dislocation in adults

Objective：Fracture of either radius or ulna with a dislocation either at the proximal or distal radioulnar joint （DRUJ） is not a common injury and is inherently unstable.Here we report a case series,with both-bone forearm fractures associated with dislocation of DRUJ,as a Galeazzi-variant type fracture-dislocation,and try to analyze this injury pattern.Methods：The study was based on 6 patients having Galeazzi-variant type fracture-dislocation of different age （20 to 45 years）.All fractures were closed type.Two fractures involved the same level and three fractures were at different levels of radius and ulna shaft.After thorough examination and investigations they were treated with limited contact dynamic compression plate without additional fixation for DRUJ.Results：All cases were followed up for 24 weeks.The maximum incidence occurred in age group between 31 and 40 years.All the fractures of both radius and ulna were united in average time of 12 weeks.Range of motion of wrist and elbow,supination and pronation at final follow-up were normal.There was no subsequent re-subluxation or dislocation of the DRUJ in any of the cases.Conclusion：Galeazzi variant in adult is a new undescribed pattern of forearm with wrist injury.Stable open reduction and internal fixation of both-bone forearm fractures is mandatory,followed by 3 to 4 weeks of immobilization in a cast for the healing of disrupted DRUJ.     

冠突前内侧面骨折与外侧副韧带损伤的治疗

目的探讨冠突前内侧骨折后,外侧副韧带是否需要全部修复。 方法选自2012年7月至2016年7月天津医院共收治的19例冠突前内侧骨折患者,排除1例合并桡骨远端骨折患者,1例既往关节炎患者。术前行影像学检查,包括肘关节正侧位X线片、CT检查,以明确损伤类型。根据O’Driscoll分型2-1型4例,2-2型9例,2-3型4例。所有患者均采用肘关节内侧入路（尺侧腕屈肌入路）,固定冠突骨折后,给予内翻应力试验,如为阳性,修复外侧副韧带;如为阴性,不修复。采用Mayo肘关节功能评分（mayo elbow performance score,MEPS）、上肢功能障碍评分（disability of arm shoulder and hand,DASH）、视觉模拟评分法（visual analogue scale/score,VAS）对肘关节功能进行评价。 结果冠突骨折固定后,内翻试验阳性患者13例,给予外侧副韧带修补术,阴性患者4例,未给予外侧副韧带修补。所有患者均获得满意的肘关节评分,MEPS平均97.6分,DASH平均4.13分,VAS平均0.4分;关节炎Broberg-Morrey标准I度5例。 结论在冠突前内侧骨折的治疗中,冠突固定后的内翻试验对于判断肘关节稳定性至关重要,外侧副韧带修复与否取决于内翻应力试验。     

Pediatric complex divergent elbow dislocation

A divergent dislocation of the elbow is a very rare injury, and only a few cases have been described in the literature. It is characterized as a dorsal dislocation of the ulnohumeral joint combined with a lateral dislocation of the proximal radius. All three articulations of the elbow joint are involved. Like in our case, it can be accompanied by an avulsion fracture of the coronoid and a distal radius fracture. For correct understanding of the injury, proper radiographic studies are imperative. In contrast to some earlier reports that advise a conservative approach, we performed a very aggressive operative treatment. To ensure anatomic reconstruction of the elbow, surgical exposure of the various injuries was performed first. After gross reduction of the joint dislocation, definitive osteosynthesis of the distal radius fracture was performed. Subsequently, the coronoid process and lateral collateral ligament could be repaired anatomically, improving the stability of the elbow. An uneventful recovery with excellent elbow motion and stability was achieved.     

腕关节镜下治疗尺骨茎突骨折

目的 探讨腕关节镜监视下治疗尺骨茎突骨折的方法,以获得更好的治疗效果.方法 对15例尺骨茎突骨折的患者,在C臂透视机及腕关节镜监视下先将合并的桡骨远端骨折进行复位,经皮穿针内固定或切开复位钢板内固定,然后在腕关节镜下检查三角纤维软骨复合体(triangular fibrocartilage complex,TFCC)是否损伤,并作修整、清理等相应的处理,在关节镜监视下将尺骨茎突骨折复位,经皮作钢丝张力带内固定.结果 11例合并有TFCC损伤,经平均15.4个月的临床随访,X线片检查显示尺骨茎突骨折全部骨性愈合,骨性愈合时间平均5.2个月.按照Green-O'Brien功能评定方法进行腕关节功能评定,优良率为93.3%,无腕关节尺侧疼痛及腕关节不稳等并发症发生.结论 腕关节镜下治疗尺骨茎突骨折既可以对骨折进行有效的复位及固定,有利于骨折的愈合;又可以了解腕关节内TFCC等结构的损伤程度,便于早期处理,以免遗留慢性腕痛或腕关节不稳定.     

Distal ulna hook plate fixation for unstable distal ulna fracture associated with distal radius fracture

The significance of distal ulna fractures is often undermined, which can result in inadequate treatment compared with fractures of the radius, the ulna's larger counterpart. However, little guidance exists in the current literature on how to manage distal ulna head or neck fractures and intra-articular ulna head fractures. Therefore, the purpose of this retrospective study was to evaluate the outcomes of distal ulna hook plate fixation for the treatment of an unstable distal ulna fracture associated with a distal radius fracture.Twenty-five patients with unstable distal ulna fractures who underwent stable fixation for an associated distal radius fracture were included in the study. All patients achieved satisfactory reduction and bony union. Average final motion was as follows: wrist flexion, 72° (range, 60°-85°); extension, 69° (range, 65°-80°); pronation, 77° (range, 55°-95°); supination, 82° (range, 65°-90°); ulnar deviation, 35° (range, 15°-50°); and radial deviation, 24° (range, 10°-40°). Average postoperative grip strength was 28 kg (range, 22-30 kg) and was 91% (range, 71%-100%) in the cases in which the dominant hand was injured and 80% (range, 65%-100%) in the cases in which the nondominant hand was injured. Average postoperative modified Mayo wrist score and Disabilities of the Arm, Shoulder and Hand score was 87 points (range, 65-100 points) and 14 points (range, 0-54 points), respectively. Chronic instability of the distal radioulnar joint was not encountered in any patient. Thus, the study demonstrated that distal ulna hook plate fixation for the treatment of unstable distal ulna fractures can achieve healing with good alignment, satisfactory function, and minimal transient morbidity.     

两种内固定治疗桡骨远端骨折伴尺骨茎突基底部骨折的疗效比较

目的 比较采用桡骨远端掌侧锁定钢板+尺骨茎突单皮质骨螺钉固定和单纯桡骨远端掌侧锁定钢板治疗桡骨远端骨折伴尺骨茎突基底部骨折的疗效.方法 将73例桡骨远端骨折伴尺骨茎突基底部骨折患者按治疗方法的不同分为观察组(采用桡骨远端掌侧锁定钢板+尺骨茎突单皮质骨螺钉固定治疗,38例)和对照组(采用单纯桡骨远端掌侧锁定钢板治疗,35...     

Elbow dislocation with ipsilateral diaphyseal forearm bone fracture: A rare injury report with literature review

Dislocation of the elbow along with shaft fractures of both bones of the ipsilateral forearm is a rare injury though elbow dislocation or fracture of the forearm bones may occur separately. Such injuries need a concentric reduction of the dislocation and an anatomical fixation of forearm bones for optimal functional outcomes. We report a case of elbow dislocation with fracture of the lateral condyle of the humerus along with fractures of shafts of the radius and ulna in a 44-year-old female. Closed reduction of the elbow and operative stabilization of all fractures were done with good clinical, radiological and functional outcomes in 2 years follow-up period. A significant degree of force is needed to produce a combined dislocation of a joint and fracture of bones around that joint and these complex injuries may be missed if the clinician is not aware of the possibility of such injuries. The fact that the previously reported cases had a posterolateral dislocation while our case had a posteromedial dislocation and a fracture of the lateral humeral condyle as well makes it unique in its presentation and worth reporting. We have also included an up to date literature review on this topic.     

Galeazzi fracture-dislocations.

Among 125 patients with the Galeazzi-type fracture-dislocation of the forearm, there were fourteen children and eighty-six adults with the classic Galeazzi lesion, and twenty-five patients with a special type -- fracture of both bones and dislocation of the distal radio-ulnar joint. Conservative management was successful only in children. In adults this method resulted in failure in 80 per cent of cases. The results of operative treatment were much better. The fracture fragments of the radius and the dislocation of the radio-ulnar joint in this complex injury are very unstable, especially in the lesion with fractures of the radius and ulna, and it appears that rigid internal fixation is necessary for the dislocation as well as the fracture. With combined fixation over half of the results were excellent.     

Combined Monteggia and Galeazzi fractures in a child: a case report and review of the literature

We present an unusual case in which a combination of Monteggia and Galeazzi fractures occurred in the same forearm. The patient was a 10-year-old male who climbed up the pole of a basketball net, caught hold of the net, then lost his grip, and fell onto his right hand. On physical examination, a complete paralysis of the radial ulnar and median nerves was recognized. X-rays showed an olecranon fracture and lateral dislocation of the radial head in the elbow joint, a dorsal dislocation of the distal bone fragments due to a fracture of the distal third of the radius, and a palmar dislocation of the distal end of the ulna at the wrist joint. The injuries were diagnosed as a combination of a Bado type III Monteggia fracture and a palmar-type Galeazzi fracture of the same arm. Manual reduction and immobilization in a plaster cast were performed. Three years after the injury, both the distal and proximal radioulnar joints were maintained in the reduction position. Range of motion was reduced minimally in extension at the patient's elbow, and there was complete recovery of all three nerves. A combination of Monteggia and Galeazzi fractures in the same arm has been reported in only two pediatric patients worldwide and in eight cases total when adult patients are included, indicating that this is an extremely rare trauma.