创伤性肘关节不稳的手术治疗

Operative treatment of posttraumatic instability of the elbow: evaluation and outcome

[目的]回顾性分析应用单臂铰链式外固定支架辅助有限内固定、周围软组织修复和重建与常规手术治疗创伤性肘关节不稳定的疗效对比。[方法]将2002年1月～2005年6月收治的117例肘关节骨折脱位患者，分别使用铰链式外固定支架辅助治疗和常规手术，术后石膏外固定治疗。采用肘关节功能评价法（JOA）评分标准对肘关节在疼痛、功能、活动度、关节动摇性和畸形5个方面在术前和术后随访时进行评分。[结果]其中86例随访完整，随访时间8～30个月，平均18．6个月。常规组和支架组术后随访在功能和活动度两方面组间评分有显著性统计学差异（P〈0．05），而在疼痛、关节动摇性和畸形组间无统计学差异（P〉0．05），两组总评分组问有显著性统计学差异（P〈0．05）。[结论]应用铰链式外固定支架辅助手术治疗肘关节不稳定性，可提高术后肘关节侧方稳定性，保证肘关节早期安全的功能锻炼，有利于骨折愈合和周围韧带的修复，是一种较好的手术辅助方法。

[ Objective] To retrospectively analyze the therapy comparison between the unilateral hinged external fixator assisting the internal fixation, soft tissue repair and reconstruction and routine surgery for elbow instability of fracture dislocation. [Method] A total of 117 cases of elbow fracture dislocation were collected from Jan. 2001 to Jun. 2005. Some patients were treated by unilateral hinged external fixator, and others were treated by routine surgery and casting external fixation. The JOA assessment was applied for the pain, function, arc of motion, articular instability and deformity of elbow joint before surgery and after operational follow-up. [ Result] Eighty-six cases were followed up by telephone and mail appointment. The average follow-up time was 18.6 months （from the range of 8 months to 30 months）. The function and arc of motion of two group patients were assessed by JOA in post-operational follow-up, showing statistical significant difference （P 〈 0.01 ） , while the pain, articular instability and deformity showing no statistical significant difference（P 〉 0.05）. The total assessment score between two groups indicates statistical significant difference. [ Conclusion]The operation in combination with unilateral hinged external fixator for treating elbow instability of fracture dislocation will enhance lateral stability of elbows, guaranteen early safe elbow function exercises, facilitate stable environment for ligaments healing, suggesting a good subsidiary operational method.