单纯肘关节脱位后残留的外翻应力成角增加及后外侧旋转平移。

Residual increased valgus stress angulation and posterolateral rotatory translation after simple elbow dislocation.

作者信息

Kerschbaum Maximilian, Thiele Kathi, Scheibel Markus, Gerhardt Christian

机构信息

Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Campus-Virchow/Campus-Mitte, Augustenburgerplatz 1, 13353, Berlin, Germany.

出版信息

Knee Surg Sports Traumatol Arthrosc. 2017 Jul;25(7):2298-2303. doi: 10.1007/s00167-016-4176-0. Epub 2016 May 24.

DOI:10.1007/s00167-016-4176-0

PMID:27221640

Abstract

PURPOSE

Purpose of this study was to evaluate increased valgus stress angulation and increased posterolateral rotatory translation after simple elbow dislocation and the associated clinical instability.

METHODS

Ten patients [three women, seven men; mean age 38 ± 11 years; mean follow-up 54 months (median 47 months; range 23-111 months)] with conservatively treated simple elbow dislocations were included into this study. The elbow function was graded by using the subjective elbow value (SEV), the Oxford Elbow Score (OES), the Mayo Elbow Performance Score (MEPS), as well as the DASH Score. Range of motion (ROM) and clinical signs of valgus and posterolateral rotatory instability (PLRI) were evaluated. Additionally, in all patients sonographic and fluoroscopic evaluation of valgus stress angulation and posterolateral rotatory translation was performed.

RESULTS

Functional scores showed excellent to good results in all patients (SEV: 92 %; OES: mean 44 ± 5 points; MES: mean 91 ± 9 points; DASH Score: mean, 4 ± 4 points). The ROM did not reveal any significant differences compared to the non-affected side. Overall, three patients presented signs of clinical instability (valgus instability: n = 1; PLRI: n = 2). Sonographically, a slightly but not significantly increased valgus stress angulation in comparison with the non-affected side was measured (n.s.). The posterolateral rotatory translation was significantly increased compared to the non-affected side (p < 0.05). In this context, sonographically, four of ten patients revealed a valgus stress angulation and seven of ten patients a posterolateral rotatory translation more than 50 % compared to the non-affected. In four patients an increased valgus stress angulation and in four patients an increased posterolateral rotatory translation could be seen fluoroscopically.

CONCLUSION

Patients after conservatively treated simple elbow dislocations show good clinical and functional results. However, a sufficient anatomical ligamentary heeling does not exist.

LEVEL OF EVIDENCE

IV.

摘要

目的

本研究旨在评估单纯肘关节脱位后外翻应力成角增加和后外侧旋转平移增加情况以及相关的临床不稳定情况。

方法

本研究纳入10例经保守治疗的单纯肘关节脱位患者[3例女性，7例男性；平均年龄38±11岁；平均随访54个月（中位数47个月；范围23 - 111个月）]。采用主观肘关节评分（SEV）、牛津肘关节评分（OES）、梅奥肘关节功能评分（MEPS）以及上肢功能障碍评分（DASH）对肘关节功能进行分级。评估活动范围（ROM）以及外翻和后外侧旋转不稳定（PLRI）的临床体征。此外，对所有患者进行超声和透视评估外翻应力成角和后外侧旋转平移情况。

结果

功能评分显示所有患者结果优良（SEV：92%；OES：平均44±5分；MES：平均91±9分；DASH评分：平均4±4分）。与未受影响侧相比，ROM未显示任何显著差异。总体而言，3例患者出现临床不稳定体征（外翻不稳定：1例；PLRI：2例）。超声检查显示，与未受影响侧相比，外翻应力成角略有增加但无显著差异（无统计学意义）。与未受影响侧相比，后外侧旋转平移显著增加（p < 0.05）。在此情况下，超声检查显示，10例患者中有4例的外翻应力成角以及10例患者中有7例的后外侧旋转平移比未受影响侧增加超过50%。透视检查可见4例患者外翻应力成角增加，4例患者后外侧旋转平移增加。