桡骨远端骨折合并同侧肘关节脱位的损伤机制及手术治疗

The injury mechanism and surgical treatment of distal radius fractm-e combined with ipsilateral elbow dislocation

目的探讨桡骨远端骨折合并同侧肘关节脱位的损伤机制和手术方法。方法2007年12月至2011年4月我院共收治桡骨远端骨折合并同侧肘关节脱位损伤7例。桡骨远端骨折按AO／ASIF分型标准确定：A3型3例，c1型2例，c3型2例。均为肘关节后脱位，其中2例合并有冠状突尖部骨折，为Regan-Morrey分型中的Ⅰ型。2例合并有前臂筋膜室间隔综合征早期表现。6例行肘关节侧副韧带修复，桡骨远端骨折均行骨折切开复位内固定术，2例经皮下行前臂深筋膜切开减压。结果术后平均随访时间为16．4个月（9—26个月），无再骨折或脱位，无伤口感染，2例前臂远端伤口二期缝合。7例桡骨远端骨折均在术后6个月内愈合，肘关节稳定，2例肘关节周围出现少量的异位骨化，但不影响肘关节活动。Cooney腕关节评分平均为89．5分（75～100分），其中优2例、良3例、中1例、差1例。Mayo肘关节功能评分平均为90．5分（75～100分），其中优4例、良2例、中1例。肩臂手残障问卷表评分（DASH）为5分（2—11分）。结论桡骨远端骨折合并同侧肘关节脱位多为高能量损伤，损伤机制为腕关节背伸位，肘关节伸直位，整个上肢受到外翻、旋后和轴向的应力。较易引起前臂筋膜室间隔综合征，通过手术修复损伤的肘关节周围韧带和复位固定桡骨远端骨折可获得良好效果。

Objective To investigate the injury mechanism and surgical treatment of distal radius fracture combined with ipsilateral elbow dislocation. Methods From December 2007 to April 2011, 7 cases of distal radius fracture combined with ipsilateral elbow dislocation were admitted into our department. The distal radius fractures were classified according to AO/ASIF classification： 3 cases of type A3, 2 cases of type C1 and 2 cases of type C3 fractures. All had posterior dislocation of the elbow. Concomitant type I Regan-Morrey coronoid tip fracture was seen in 2 patients. 2 patients had early signs of forearm compartment syndrome. Among the 7 elbow dislocations, 6 cases were treated with collateral ligament repair. The distal radius fractures all underwent open reduction and internal fixation. Forearm deep fascia decompression was done in the 2 cases with compartment syndrome. Results Postoperatively the patients were follow-up for an average of 16.4 months （range, 9 to 26 months）. There was no re-fracture or dislocation, and no wound infections. The distal forearm wound was closed secondarily in the 2 cases of forearm decompression. All the distal radius fractures healed after 6 months. The elbows were all stable. A small amount of heterotopic ossification was seen in 2 eases, but did not affect elbow movement. Cooney wrist score was 89.5 （range, 75 to 100）, rating the wrist function as excellent in 2 cases, good in 3 cases, fair in 1 case and poor in 1 ease. Mayo elbow score was 90.5 （range, 75 to 100）, rating the elbow function as excellent in 4 eases, good in 2 cases and fair in 1 case. DASH score averaged 5 （range, 2 to 11）. Conclusion Distal radial fractures combined with ipsilateral elbow dislocations were mostly high-energy injury. The injury mechanism is the eversion, supination and axial stress to the upper limb with wrist in dorsifiexion position and elbow in extension position. This injury is prone to forearm compartment syndrome. Sumical revair of elbow ligaments and fixation of the distal radius fracture can achieve good results.