中国修复重建外科杂志

中国修复重建外科杂志

肘关节后内侧旋转不稳的研究进展

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目的 综述肘关节后内侧旋转不稳(posteromedial rotatory instability,PMRI)的研究进展。 方法 查阅国内外有关肘关节 PMRI 病理解剖、生物力学、诊断及治疗的研究文献,并进行总结分析。 结果 外侧韧带复合体(lateral collateral ligament complex,LCLC)损伤、内侧韧带复合体(medial collateral ligament complex,MCLC)后束损伤以及冠突前内侧面骨折是导致肘关节 PMRI 的重要因素。临床检查包括肘关节内翻及外翻应力试验等;X 线片可显示骨折情况,CT 尤其是三维重建诊断价值更大,另外 MRI、关节镜及动态超声等可辅助判断软组织损伤情况。LCLC 及 MCLC 的修复重建及冠突骨折的固定对恢复肘关节稳定性至关重要。韧带损伤的治疗有原位修复及功能重建,具体包括直接缝合、钻孔修复、带线锚钉修复、移植修补等;冠突骨折的治疗包括螺钉固定、钢板固定、不可吸收线缝合固定及关节镜技术等。 结论 恢复关节稳定性及早期功能锻炼是治疗肘关节 PMRI 的重要原则。根据受伤机制采用个体化治疗方案,可保护软组织、降低术后并发症及提高功能预后,最终改善患者生活质量。

Objective To summarize the research progress in posteromedial rotatory instability (PMRI) of the elbow joint. Methods The recent researches about the management of PMRI of the elbow joint from the aspects of pathological anatomy, biomechanics, diagnosis, and therapy were analyzed and summarized. Results The most important factors related to PMRI of the elbow joint are lateral collateral ligament complex (LCLC) lesion, posterior bundle of the medial collateral ligament complex (MCLC) lesion, and anteromedial coronoid fracture. Clinical physical examination include varus and valgus stress test of the elbow joint. X-ray examination, computed tomography, particularly three-dimensional reconstruction, are particularly useful to diagnose the fracture. Also MRI, arthroscopy, and dynamic ultrasound can assistantly evaluate the affiliated injury of the parenchyma. It is important to repair and reconstruct LCLC and MCLC and fix coronoid process fracture for recovering stability of the elbow joint. There are such ways to repair ligament injury as in situ repairation and functional reconstruction, which include direct suturation, borehole repairation, wire anchor repairation, and transplantation repairation etc. The methods for fixation of coronal fracture include screw fixation, plate fixation, unabsorbable suture fixation, and arthroscopy technology. Conclusion It is crucial that recovering the stability of the elbow joint and early functional exercise for the treatment of PMRI. Individual treatment is favorable to protect soft tissue, reduce surgical complications, and improve the functional recovery and the quality of life.

关键词: 肘关节; 后内侧旋转不稳; 外侧韧带复合体; 内侧韧带复合体

Key words: Elbow joint; posterolateral rotatory instability; lateral collateral ligament complex; medial collateral ligament complex

引用本文: 龙能吉, 何树坤, 吴仕舟, 黄富国. 肘关节后内侧旋转不稳的研究进展. 中国修复重建外科杂志, 2018, 32(4): 505-510. doi: 10.7507/1002-1892.201710101 复制

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