手术治疗闭合复位失败的单纯创伤性桡骨头脱位的疗效分析

Treatment of isolated traumatic radial head dislocation after failed close reduction

目的探讨手术治疗闭合复位失败的单纯创伤性桡骨头脱位(ITRHD)的疗效。方法回顾性分析自2011年1月至2020年12月北京积水潭医院创伤骨科共收治的8例闭合复位失败的ITRHD患者资料。男2例,女6例;年龄15~41岁,平均27岁;左侧3例,右侧5例。所有患者均采用手术治疗。末次随访时记录肘关节屈伸活动范围和前臂旋转活动范围,并采用Mayo肘关节功能评分(MEPS)评估肘关节功能。结果8例患者术后获2~13个月(平均4.5个月)随访。末次随访时患者屈伸活动度平均136.9°,旋转活动度平均143.8°。8例患者均无明显疼痛及关节不稳定,除1例前臂旋转明显受限外,其余7例活动功能良好,8例患者的MEPS评分均为满分。结论闭合复位失败的ITRHD应及时行手术治疗,其疗效稳定可靠,术中尽量避免克氏针贯穿固定上尺桡关节,术后应早期进行关节全范围活动。

Objective To explore the surgical treatment of isolated traumatic radial head dislocation(ITRHD)after failed close reduction.Methods A retrospective study was conducted of the 8 patients with ITRHD who had been admitted to Department of Orthopaedic Trauma,Beijing Jishuitan Hospital for operation after failed close reduction from January 2011 to December 2020.They were 2 males and 6 females,aged from 15 to 41 years(average,27 years).The left elbow was injured in 3 patients and the right elbow in 5.At the last follow-up,elbow flexion-extension and forearm pronation-supination were recorded and Mayo Elbow Performance Score(MEPS)was used to evaluate functional recovery.Results The 8 patients were followed up for 2 to 13 months(mean,4.5 months).At the last follow-up,elbow flexion-extension averaged 136.9°and forearm pronation-supination 143.8°.None of the 8 patients had significant pain or joint instability.Of them,7 had good motor function but one reported significant limitation of forearm rotation.All the 8 patients scored a full MEPS mark.Conclusions If close reduction failed,ITRHD should be treated in time by operative treatment the efficacy of which is reliable.Fixation of the proximal radial-ulnar joint with Kirschner wire should be avoided.Early exercise for full range of elbow motion is necessary.