Surgical treatment of acute convergent dislocation of elbow北大核心CSCD

Objective To evaluate the surgical treatment of acute convergent dislocation of elbow after failed closed reduction. Methods A retrospective study was conducted of the 8 patients with acute convergent dislocation of elbow who had been admitted from January 2017 to December 2020 for surgical treatment after failed closed reduction and completely followed up at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. There were 3 males and 5 females, with an average age of 30.9 years (from 15 to 51 years). Five left and 3 right elbows were injured. Combined injuries included radial head fracture in 6 cases, distal radius fracture in 2 cases, coronoid fracture in one, medial epicondyle fracture of the humerus in one, scaphoid fracture in one, and distal radioulnar dislocation in one. All patients underwent surgery after failure of closed reduction. Intraoperative exploration found in every case a longitudinal tear on the brachialis tendon. The radial head protruded from the front into the tear and twisted the tendon so that the reduction of the radial head was frustrated. At the last follow-up, the elbow flexion and extension and forearm rotation were recorded, and the Mayo elbow performance score (MEPS) was used for function assessment. Results All the 8 patients were followed up for a mean of 6.1 months (from 2 to 12 months). At the last follow-up, the elbow flexion and extension averaged 101.9° (from 65° to 150°), the forearm rotation 132.5° (from 75° to 170°), and the MEPS 96.3 (from 90 to 100). None of the patients had significant pain or joint instability. Various degrees of joint mobility limitation existed in 7 patients, one of whom underwent elbow arthrolysis and another of whom underwent ulnar neurolysis and anterior transposition due to ulnar nerve injury. Conclusions For treatment of acute convergent dislocation of elbow, if closed reduction fails, surgical treatment should be performed on time, because the surgical efficacy is more reliable. As the severity and combined injuries of the convergent dislocation vary from person to person, the therapy algorithm should be individualized. © 2023 Chinese Journal of Orthopaedic Trauma. All rights reserved.     

急性汇聚型肘关节脱位的手术疗效分析

目的探讨手术治疗急性汇聚型肘关节脱位的疗效。方法回顾性分析2017年1月至2020年12月北京积水潭医院创伤骨科共收治的8例急性汇聚型肘关节脱位患者资料。男3例, 女5例;年龄15～51岁, 平均30.9岁;左侧5例, 右侧3例。合并伤:桡骨头骨折6例, 桡骨远端骨折2例, 冠状突骨折1例, 肱骨内上髁骨折1例, 腕舟骨骨折1例, 下尺桡脱位1例。所有患者均闭合复位失败后采取手术治疗。术中探查发现阻挡桡骨头复位的因素均为肱肌腱纵向撕裂, 桡骨头从前方进入肱肌腱撕裂口而发生绞锁。末次随访时记录肘关节屈伸和前臂旋转活动范围, 并采用Mayo肘关节功能评分(MEPS)评估功能。结果所有患者术后获2～12个月(平均6.1个月)随访。末次随访时屈伸活动度平均101.9°(65°～150°)、旋转活动度平均132.5°(75°～170°)。8例患者均无明显疼痛及关节不稳定, 末次随访时MEPS评分平均96.3分(90～100分)。7例存在不同程度的关节活动受限, 其中1例行肘关节松解术。1例因尺神经损伤行尺神经松解前移术。结论闭合复位失败的汇聚型肘关节脱位应及时行手术治疗, 其疗效相对可靠。因为该...