肘关节后外侧旋转不稳定的研究进展

目的综述肘关节后外侧旋转不稳定(posterolateral rotatory instability,PLRI)的病理解剖、诊断及治疗进展。方法查阅国内外有关肘关节PLRI研究的相关文献,并进行综合分析。结果肘外侧韧带复合体(lateralcollateral ligament complex,LCLC)、桡骨头、肱骨小头及尺骨冠突损伤是导致肘关节PLRI的重要因素,跨越肘外侧的肌群起次要作用。临床检查主要包括侧方轴移试验、侧方轴移恐惧试验、撑椅征、俯卧撑试验、撑桌试验和后外侧旋转抽屉试验。影像学、关节镜及超声检查可以协助诊断PLRI。损伤的LCLC可采用骨性固定重建或软组织固定重建方式。结论 LCLC是PLRI的首要限制结构。超声能准确识别并测量正常的LCLC,有望成为一种可靠的无创检查方法。软组织固定重建方式避免了医源性骨折的缺点,是一种可选择的治疗方法。

Research progress of posterolateral rotatory instability of the elbow

Objective To review the progress in pathoanatomy,diagnosis,and treatment of posterolateral rotatory instability(PLRI) of the elbow.Methods Related literature concerning PLRI of the elbow was extensively reviewed,comprehensive analysis was done.Results The lateral collateral ligament complex(LCLC),radial head,capitellum,and coronoid process are important constraints to PLRI.Muscle groups that cross the lateral elbow are secondary constraints to PLRI.Clinical examination includes lateral pivot-shift test,lateral pivot-shift apprehension test,chair sign,active floor push-up sign,tabletop relocation test,and posterolateral rotatory drawer test.Radiology,arthroscopy,and ultrasound can help diagnosis of PLRI.Reconstruction of bony fixation or soft tissue fixation can be used for treatment of injured LCLC.Conclusion The primary constraints to PLRI is LCLC.Ultrasound imaging is accurate for identification and measurement of normal LCLC.Therefore,ultrasound may prove valuable in assessment of abnormal lateral ulnar collateral ligaments.Reconstruction of soft tissue fixation,which can avoid iatrogenic fracture,is a selective treatment method.