单纯肘关节后脱位需要严格制动吗?

Does simple posterior dislocation of the elbow necessitate strict immobilization?

目的 探讨单纯肘关节后脱位复位后的治疗方法。 方法 36例单纯肘关节后脱位患者 ,男 2 6例 ,女 10例 ,平均年龄 2 2岁 ;左侧 14例 ,右侧 2 2例 ;主力侧上肢 2 1例 ,非主力侧 15例。闭合复位成功后 ,通过内外翻应力试验及推拉前臂证实患肘关节在屈曲 30°～ 130°的范围内稳定性良好。对 30例小于 35岁的患者用长臂石膏后托制动于屈肘 90°,前臂旋前位 1周 ;对 6例 35岁以上患者仅用颈腕吊带制动 3～ 5d ,肿胀和疼痛减轻后立即开始主动功能锻炼 ,但刚开始的 1～ 2周限制其最后的 30°伸肘。告知所有患者切忌强力被动活动及牵拉肘关节。 结果 本组病例随访时间 3～ 15个月 ,平均随访 9个月。所有患者在伤后 3～ 4个月恢复了运动范围和肌力。 32例与健侧相比完全恢复 ,4例 35岁以下者伸肘受限在 5°～ 10°之间。未出现不稳定的症状和体征 ,亦未发生复发性肘关节脱位 ;X线片检查也未发现创伤性骨化及骨关节病征象。 结论 肱尺关节具有良好的内在稳定性 ,其骨性稳定足以保证肘关节在进行功能活动的同时 ,关节囊、韧带等软组织愈合良好。对单纯肘关节后脱位采取短期制动 (不超过 1周 ) ,早期功能锻炼是可取的 。

Objective [WT5”BZ]To research for the ideal treatment of isolated posterior dislocation with the elbow after reduction. Methods 36 patients of isolated posterior dislocation of the elbow after closed reduction (male 26, female 10; left 14, right 22; dominant extremity 21,undominant extremity 15;average age 22) were examined by varus and valgus stress test and push draw test. Satisfactory stability from 30° to 130° flexion of the elbow was found in all patients. For the 30 patients below 35 years old,long arm posterior splint was applied to immobilize the elbow joint at 90° flexion and pronation for one week. For 6 patients over 35 years old, we only immobilized the elbow joint for 3 to 5 days with a neck wrist sling. Prompt active motion begain after the swelling and pain reduced slightly, but the last 30 extension was not allowed for the first 1 to 2 weeks. Forceful passive motion and stretching of the elbow joint were avoided in all patients. Results The average follow up time was 9 months (3 15 months). Range of motion and muscle power were regained within 3 4 months. 32 patients rehabilitated completely and 4 of the 6 patients decreased extension for 5° 10°. No unstable symptoms and signs or recurrent dislocation were found. No ectopic calcification or post traumatic arthritic changes were found on X ray follow up. Conclusions The ulnohumeral joint is one of the most highly constrained joints in the body with intrinsic stability. Bony structure is stable enough to allow for capsular and ligamental structure healing, even during active motion. For isolated posterior dislocation of the elbow joint, short term immobilization and early functional exercise are desirable. Elbow instability and recurrent dislocation are rare and do not necessitate long term strict immobilization.