上尺桡关节松解改善肘部创伤后前臂旋转受限

目的 探讨上尺桡关节松解改善肘部创伤后前臂旋转受限的效果.方法 2007年1月至12月共收治12例肘部创伤后前臂旋转受限患者,男9例,女3例;左侧3例,右侧9例.患者初次治疗时平均年龄为37.7岁(27～48岁).原始损伤包括:"恐怖三联征"3例,尺骨近端骨折4例,桡骨头骨折4例,冠状突骨折1例.11例患者松解术前有手术史.受伤至松解手术时间平均9个月(6～27个月).松解术前患者前臂旋前平均17.5°(0～80°),旋后平均39.1°(0～90°),前臂旋转活动度平均56.7°(0～130°).7例采用后侧入路,3例采用内、外侧联合入路,2例采用单纯外侧入路.术中去除上尺桡关节周围增生瘢痕及骨赘,如上尺桡关节已融合,则切除中间骨桥,注意保护肱二头肌腱止点,尽量保留桡骨头,术中尽量达到旋前80°,旋后90°.术后第1天开始主动及被动功能锻炼,并常规口服吲哚美辛预防异位骨化.结果 12例患者术后获平均18.3个月(14～25个月)随访.松解术后患者旋前平均70.8°(60°～80°),旋后平均86.7°(70°～90°),前臂旋转活动度平均为157.5°(130°～170°).术后前臂旋转功能按Failla标准 2]评定:12例患者皆为优.6例合并异位骨化患者松解术后1例复发异位骨化,7例采用后侧入路患者2例出现皮下血肿,均未做特殊处理.12例患者均未出现感染、肘关节不稳定及上尺桡关节脱位等情况.结论 对于肘部创伤后前臂旋转受限患者,术前审慎评估肘关节功能情况,术中仔细松解上尺桡关节,尽量保留桡骨头,术后早期主动及被动功能锻炼,可以取得良好的临床疗效.

Proximal radioulnar arthrolysis to improve the rotation of the forearm

Objective To discuss the proximal radioulnar arthrolysis for the treatment of rotatory dysfunction of the forearm after elbow injury. Methods From January to December 2007,we treated 12 patients with limited rotation of the forearm following elbow injury. They were 9 males and 3 females (3 left elbows and 9 right elbows),averaging 37.7 (27 to 48) years. Their primary injuries included "terrible triad" (3),proximal ulnar fracture (4),radial head fracture (4) and coronoid fracture (1). Before open arthrolysis,11 patients had had operation. The average time from injury to open arthrolysis was 9 (6 to 27) months. The average rotation of the forearm before arthrolysis was 56.7°(0 to 130°). We treated 7 patients through posterior approach,3 through combined bilateral approaches and 2 through lateral approach. Scar tissue,osteophyte and ectopic ossification around the proximal radioulnar joint were resected,but the radial head was retained if possible. Possible measures were tried to maintain pronation at 80° and supination at 90° during operation. The patients began active and passive exercises the first day after operation. Indomethacin was administered the first day after open arthrolysis as a routine. Results All patients were followed up for 14 to 25 (average,18.3) months. The patients got an average of 157.5° (130° to 170°) of rotation of the forearm. No elbow instability or dislocation of the proximal radioulnar joint was found. Conclusion Careful open arthrolysis of the proximal radioulnar joint and early rehabilitative exercise can lead to good results for rotatory dysfunction of the forearm after elbow injury.