Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
Clin Orthop Relat Res. 2010 Sep;468(9):2410-8. doi: 10.1007/s11999-010-1283-y. Epub 2010 Mar 4.
Treatment of chronic radial head dislocation is controversial, considering whether to reduce and reconstruct the proximal radioulnar joint. The anatomic alteration that influences the decision to reduce the dislocation is not completely understood.
QUESTIONS/PURPOSES: We attempted to clarify the changes of the proximal radioulnar joint that occur in chronic radial head dislocations to clarify how they might influence the decision to perform repair.
We evaluated 15 patients with chronic radial head dislocations categorized by duration of "early" (< 3 years) (n = 8) and "longstanding" (> 3 years) (n = 7) groups. We measured the angle and depth of the radial notch of the proximal ulna and evaluated radial head deformity using 3-D bone models created from CT data.
For the early group, no differences were observed in the shape of the radial notch between affected and normal sides. For the longstanding group, the radial notch angle was greater on the affected side (mean +/- SD, 45.5 degrees +/- 9.7 degrees ) than on the normal side (29.7 degrees +/- 6.3 degrees ), and the radial notch depth was smaller on the affected side (0.2 +/- 1.6 mm) than on the normal side (2.3 +/- 1.3 mm). The shape of the radial head was nearly normal in the early group, whereas the longstanding group had a dome-shaped deformity.
In longstanding chronic radial head dislocation, deformation develops in the radial head and radial notch of the ulna, which is remodeled in a manner corresponding to the dislocated position of the radial head.
Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
慢性桡骨头脱位的治疗存在争议，需要考虑是否需要复位和重建桡尺近端关节。影响复位决策的解剖学改变尚不完全清楚。
问题/目的：我们试图阐明慢性桡骨头脱位中桡尺近端关节的变化，以阐明它们如何影响修复的决策。
我们评估了 15 例慢性桡骨头脱位患者，根据病程分为“早期”(<3 年)(n=8)和“长期”(>3 年)(n=7)组。我们测量了尺骨近端桡切迹的角度和深度，并使用 CT 数据创建的 3D 骨模型评估了桡骨头的畸形。
对于早期组，患侧和健侧桡切迹的形状没有差异。对于长期组，患侧桡切迹角较大(平均 +/- 标准差，45.5 度 +/- 9.7 度)，健侧较小(29.7 度 +/- 6.3 度)，患侧桡切迹深度较小(0.2 +/- 1.6 毫米)，健侧较大(2.3 +/- 1.3 毫米)。早期组桡骨头的形状基本正常，而长期组则呈穹顶状畸形。
在慢性桡骨头脱位的长期病程中，桡骨头和尺骨桡切迹会发生变形，这种变形会根据桡骨头的脱位位置进行重塑。
III 级，预后研究。欲了解完整的证据水平描述，请参见作者指南。
