铰链外固定架在肘关节内翻-后内侧旋转不稳定损伤中的应用观察

Efficacy of hinge external fixator in varus posteromedial rotational instability

目的探讨肘关节铰链外固定架在肘关节内翻-后内侧旋转不稳定损伤中的临床疗效。方法采用肘关节内外侧联合入路+肘关节铰链外固定架治疗肘关节内翻-后内侧旋转不稳定损伤22例,分析患者术后骨折愈合情况、上肢功能损伤(DASH)评分、Mayo评价系统(MEPS)评价肘关节的功能。结果所有患者均获随访,平均随访时间16.23个月(12~24个月),骨折均愈合。末次随访患者肘关节功能情况,即屈曲(137.6±4.2)°、伸直(4.7±2.6)°、旋前(82.7±3.8)°、旋后(85.1±4.2)°;末次随访MEPS系统评定疗效,优12例,良5例,可4例,差1例,优良率为81.82%。结论采用内外侧联合入路,固定冠状突、修补肘关节外侧副韧带尺侧束、辅以铰链外固定架固定,是治疗肘关节内翻-后内侧旋转不稳定损伤、恢复肘关节稳定性、早期行功能锻炼的有效方法。

Objective To explore the clinical effect of hinge external fixator in varus posteromedial rotational instability （VPRI）. Methods A Retrospective method was made to analyze the clinical data of 22 patients with VPRI who were treated by internal and external combined approach and hinge external fixation. An analysis of postoperative fracture healing, upper extremity dysfunction （DASH） score and evaluation of elbow function by Mayo Evaluation System （MEPS） was made. Results All patients were followed up for an average follow - up of 16.23 months （ 12 to 24 months）. All patients had fractures healed. The last follow - up of patient elbow function were as follow ： flexion （ 137.6 ± 4.2 ） °, straight （ 4.7 ± 2.6 ）°, pronation （ 82.7 ± 3.8 ） °, supination （ 85.1 ± 4.2 ）°. The last follow - up assessment of efficacy by MEPS system as follow：excellent in 12 cases,good in 5 cases,tolerableness in 4 cases,poor in 1 case, the excellent rate was 81.82%. Conclusion The use of internal and external combined approach, fixation of the coronary process, repairmen of ulnar fasciculus of lateral collateral ligament, combined with hinge external fixation,is the efficient method of treating VPRI, restoring elbow stability and carrying out early functional exercise.