成功治疗陈旧性Essex-Lopresti损伤病例讨论

Successful Treatment of Old Essex-Lopresti Injury

目的探讨Essex-Lopresti损伤的作用机制及治疗原则。方法对我院收治的1例陈旧性Essex-Lopresti损伤进行回顾性分析,并复习相关文献。结果本例因桡骨头切开复位内固定术后肘腕活动受限2个月入院。专科查体:右肘关节活动受限,屈伸活动度30°~60°,前臂旋前活动度30°,旋后活动度10°,右腕关节掌屈20°,背伸40°。摄X线片示:右桡骨头粉碎性骨折内固定术后,下桡尺关节脱位,桡骨向近端短缩。诊断为陈旧性Essex-Lopresti损伤,行人工桡骨头置换术并尺骨短缩截骨术。随访1年,尺骨截骨端已愈合,下尺桡关节未脱位,肘腕关节功能恢复良好。结论人工桡骨头置换术并尺骨短缩截骨术治疗陈旧性Essex-Lopresti损伤效果满意。

Objective To analyze the mechanism of Essex-Lopresti injury（ELI） and its treatment principle. Methods The clinical data of a patient with old ELI treated in our hospital were analyzed retrospectively and the related literature was reviewed. Results This patient was admitted to our hospital due to cubital and wrist movement limitation after open reduction and internal fixation of the radial head for 2 months. Physical examination revealed that the movement of the right elbow was limited,with flexion and extension of 30°-60°,forearm pronation of30°,forearm supination of 10°,right wrist metacarpal flexion of 20°,anddorsal extension of 40°. X-ray examination showed internal fixation of comminuted fracture of right radial head,dislocation of lower radioulnar joint,and shortening of radius to proximal end. The patient was diagosed with old ELI. Artificial radial head replacement with ulnar shortening osteotomy was performed. At 1-year follow-up,the end of ulnar osteotomy was healed,the lower ulnar and radial joint was not dislocated,and the function of the elbow and wrist joint recovered well. Conclusion In the treatment of old ELI,artificial radial head replacement combined with ulnar shortening osteotomy has satisfactory effects.