个性化处理急性肘关节骨折脱位术后关节不稳定的疗效观察

Clinical observation of effect on personalized operation for postoperative instability of acute elbow fracture and dislocation

目的分析急性肘关节骨折脱位术后不稳定的原因及后续处理措施。方法回顾性分析自2021年8月至2022年1月于首都医科大学附属北京积水潭医院创伤骨科所有急性肘关节骨折脱位并采用手术治疗患者的临床资料,从中检索术后第1次摄片复查时出现肱尺关节脱位及半脱位或采用克氏针强行将肱尺关节固定患者,共13例。分析13例患者的损伤分型和术中修复结构、后续处理措施,并记录患者末次随访时肘关节活动度及Mayo肘关节功能评分(MEPS)。结果13例患者术后获4~8.5个月(平均6.5个月)随访。所有患者伤口均一期愈合,无血管损伤,1例桡神经损伤,后期2例尺神经麻痹,5例肘关节强硬。末次随访时患者肘关节屈伸范围40°~135°,平均95.8°;前臂旋转度为5°~155°,平均117.4°;MEPS评分为55~100分,平均89.5分,优4例,良6例,可2例,差1例。结论正确认识急性肘关节骨折脱位的损伤机制,有效修复肘关节各个损伤结构,可避免术后肘关节早期不稳定。如出现了不稳定,需区别处理,欠稳定者,只需支具固定保护,避免肘关节内外翻及过度伸直;对于严重的不稳定患者,应采用铰链式外固定架固定,避免使用克氏针直接固定肱尺关节。

Objective To analyze the causes of postoperative instability of acute elbow fracture and dislocation and the follow-up measures.Methods From August 2021 to January 2022,the clinical data of all patients with acute elbow fracture and dislocation in the Department of Trauma and Orthopaedics of Beijing Jishuitan Hospital who were treated surgically were retrospectively analyzed.Thirteen patients with humeral ulnar joint dislocation and subluxation or forced fixation of the humeral ulnar joint with Kirschner wire during the first postoperative film review were retrieved,And record the patient's elbow joint range of motion and Mayo elbow joint function score(MEPS)at the last follow-up.Result 13 patients were followed up for 4-8.5 months(average 6.5 months)after surgery.The wounds of all patients were healed in the first stage without vascular injury,1 case of radial nerve injury,2 cases of ulnar nerve paralysis in the later stage,and 5 cases of elbow joint stiffness.At the last follow-up,the elbow joint flexion and extension range of patients was 40°to 135°,with an average of 95.8°.The forearm rotation is 5°to 155°,with an average of 117.4°;The MEPS ranges from 55 to 100 points,with an average of 89.5 points.There are 4 excellent cases,6 good cases,2 fair cases,and 1 poor case.Conclusion Correctly understand the injury mechanism of acute elbow joint fracture dislocation,effectively repair each injury structure of elbow joint,which can avoid early instability of elbow joint after operation.It needs to be treated differently in case of instability.For those who are less stable,only braces need to be fixed and protected to avoid inversion and excessive straightening of the elbow joint.For severely unstable patients,a hinged external fixation frame should be used to avoid using Kirschner wires to directly fix the humeral ulnar joint.