手术与非手术治疗肘关节后脱位伴尺侧副韧带损伤的临床研究

The clinical research on posterior dislocation of elbow joint combined with collateral ligament injury at ulna side by surgery or non-operative management

目的探讨手术治疗与非手术治疗急性肘关节后脱位伴尺侧副韧带损伤的临床疗效。方法回顾性分析我院2007年3月～2011年1月收治入院的30例闭合性肘关节后脱位伴尺侧副韧带损伤患者的临床资料。其中手术治疗22例,非手术治疗8例,比较治疗后两组患者疼痛、稳定性、运动、力量等方面的临床疗效。结果本组30例患者均获随访,平均术后随访时间12个月。非手术组患者治疗后外翻应力比手术组高,两组比较差异有统计学意义(P<0.000 1),说明手术治疗组其患肘内侧间隙更贴近伤前正常时生理间隙。根据Broberg-Morrey评分系统,手术组在疼痛、稳定性等方面评分要高于非手术组,在运动、力量方面比较差异无统计学意义(P>0.05);手术组优良率为100%,非手术组优良率为75%,两组比较差异有统计学意义(P<0.05)。结论早期手术修复尺侧副韧带,可使韧带断端对合良好、间隙小、组织修复快,但要积极预防手术并发症。

Objective To explore the effectiveness of posterior dislocation of elbow joint combined with collateral ligament injury at ulna side by surgery or non-operative management. Methods The clinical data of 30 patients with posterior dislocation of elbow joint combined with collateral ligament injury at ulna side from March 2007 to January 2011 in our hospital were retrospectively analyzed. 22 cases were treated by surgical performance, while another 8 cases were applied with non-operative management. The clinical curative effect of pain, stability, sports, strength and other aspects after treatment were compared between the patients in two groups. Results All 30 cases had been followed up with the average of 12 months. The valgus stress of non-operative group was higher than that in operative group, it had statistical differences （P 〈 0.000 1）. The results showed that the gap inside elbow was more close to the normal physiological clearance before the injury in surgical treatment group. According to the score of Broberg-Morrey, the scores of pain and stability of joints were higher than that in non-operative group, while sports and power functions had no statistical difference between two groups （P 〉 0.05）. The excellence rate was 100% in operation group, as it was 75% in non-operative group, it had statistical difference （P 〈 0.05）. Conclusion Reparation on collateral ligament injury at ulna side by surgery early, it can make the broken ends of ligament well healed, small gap and rapid reparations, but should actively prevent complications.