Lindenhovius Anneluuk L C, Jupiter Jesse B, Ring David
Harvard Medical School, Boston, MA, USA.
J Hand Surg Am. 2008 Jul-Aug;33(6):920-6. doi: 10.1016/j.jhsa.2008.02.007.
To test the null hypothesis that there is no difference in flexion arc or Broberg and Morrey rating between patients treated within 2 weeks of the injury (acute treatment) and those treated 3 weeks or more after injury with persistent or recurrent dislocation or subluxation (subacute treatment).
The acute cohort consisted of 18 patients treated an average 6 days after injury. The radial head was replaced in 17 patients and repaired with screw in 1, the coronoid was secured with suture in all patients and with an additional screw in 2, and the lateral collateral ligament was reattached in all patients. No external fixators were applied. Four of 14 patients in the subacute cohort had 5 operative procedures before presenting to us. All patients presented with instability and were treated an average 7 weeks after injury. Except for 1 patient who presented with an active infection, all patients were treated with radial head replacement and lateral collateral ligament repair, and fixation or reconstruction of the coronoid occurred in 9 patients. Stability was protected with a hinged external fixator for an average of 6 weeks.
Five patients in the acute cohort and 1 in the subacute cohort had 8 subsequent surgeries (addressing stiffness in 3 patients). Prior to subsequent surgeries, the flexion arc averaged 116 degrees in the acute cohort and 93 degrees in the subacute cohort and improved to an average 119 degrees in the acute cohort and 100 degrees in the subacute cohort after all subsequent surgeries. Broberg and Morrey scores were comparable between cohorts (90 vs 87 points).
Stability and strength were restored with both acute and subacute treatment, but earlier treatment is more straightforward and is associated with a better flexion arc.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
检验零假设，即受伤后2周内接受治疗的患者（急性治疗）与受伤3周或更长时间后因持续性或复发性脱位或半脱位而接受治疗的患者（亚急性治疗）在屈曲弧度或布罗伯格和莫里评分方面无差异。
急性治疗组由18例平均在受伤后6天接受治疗的患者组成。17例患者进行了桡骨头置换，1例用螺钉修复，所有患者均用缝线固定冠突，2例额外加用螺钉，所有患者均重新附着外侧副韧带。未应用外固定器。亚急性治疗组14例患者中有4例在前来我院就诊前接受了5次手术。所有患者均表现为不稳定，平均在受伤后7周接受治疗。除1例出现活动性感染的患者外，所有患者均接受了桡骨头置换和外侧副韧带修复，9例患者进行了冠突固定或重建。用铰链式外固定器平均固定6周以维持稳定性。
急性治疗组5例患者和亚急性治疗组1例患者随后进行了8次手术（3例患者针对僵硬问题）。在随后的手术前，急性治疗组的屈曲弧度平均为116度，亚急性治疗组为93度，在所有随后的手术后，急性治疗组平均改善至119度，亚急性治疗组为100度。两组的布罗伯格和莫里评分相当（90分对87分）。
急性和亚急性治疗均恢复了稳定性和强度，但早期治疗更直接，且与更好的屈曲弧度相关。
研究类型/证据水平：治疗性III级。
