Grafe Michael W, McAdams Timothy R, Beaulieu Christopher F, Ladd Amy L
Department of Orthopaedic Surgery, Stanford University Hospital, Palo Alto, California 94304, USA.
Am J Orthop (Belle Mead NJ). 2003 Oct;32(10):501-3; discussion 504.
Posterolateral rotatory instability of the elbow can be difficult to diagnose and requires a high degree of clinical suspicion. Cases of chronic posterolateral rotatory instability (symptoms present more than 1 year) may be an even more perplexing subgroup. This is a case report of a patient with a 30-year history of intermittent elbow instability. Clinical examination was equivocal, and magnetic resonance imaging was unable to define any ligamentous injury around the elbow. Examination under anesthesia and surgical findings were consistent with complete disruption of the lateral ulnar collateral ligament. The 12-month follow-up after surgical reconstruction showed complete resolution of symptoms. Posterolateral rotatory instability is a diagnosis largely made by examination under anesthesia. A thorough history and a high clinical suspicion are necessary to support the physician's decision to place the patient under anesthesia. Confirmation of a chronic tear of the lateral ulnar collateral ligament of the elbow with magnetic resonance imaging can be difficult and sometimes misleading.
肘关节后外侧旋转不稳定可能难以诊断，需要高度的临床怀疑。慢性后外侧旋转不稳定（症状出现超过1年）的病例可能是一个更令人困惑的亚组。这是一例有30年间断性肘关节不稳定病史患者的病例报告。临床检查结果不明确，磁共振成像无法确定肘关节周围的任何韧带损伤。麻醉下检查及手术所见与尺侧副韧带完全断裂相符。手术重建后12个月的随访显示症状完全消失。后外侧旋转不稳定很大程度上是通过麻醉下检查做出的诊断。详尽的病史和高度的临床怀疑对于支持医生让患者接受麻醉的决定很有必要。通过磁共振成像确认肘关节尺侧副韧带慢性撕裂可能困难且有时会产生误导。
