Schnetzke Marc, Porschke Felix, Hoppe Karin, Studier-Fischer Stefan, Gruetzner Paul-Alfred, Guehring Thorsten
1Department of Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwigshafen on the Rhine, Germany.
J Bone Joint Surg Am. 2017 Jun 21;99(12):1043-1050. doi: 10.2106/JBJS.16.01203.
The aim of this study was to investigate the outcomes in a large series of Essex-Lopresti injuries (ELIs) and to compare patients with early and late diagnoses.
Thirty-one patients with an ELI (average age and standard deviation [SD], 46 ± 10 years) who were followed for a minimum of 2 years were included in the study. Patients were grouped according to whether the ELI had been diagnosed early (on the day of the injury) or late (>4 weeks after the radial head injury). Acute treatment of early-diagnosed ELI included temporary stabilization of the distal radioulnar joint (DRUJ) by Kirschner wires with the forearm in supination for 6 weeks. Clinical outcomes were assessed on the basis of the range of motion, Mayo Elbow Performance Score (MEPS), Mayo Wrist Score (MWS), visual analog scale (VAS) score for wrist and elbow pain, and Disabilities of the Arm, Shoulder and Hand (DASH) score.
The ELI was diagnosed on the day of the injury in 16 patients (52%; the early group) and late (at a mean of 7 ± 7 months; range, 1 to 24 months) in 15 (48%; the late group). After a mean duration of follow-up of 5.3 ± 3.0 years (range, 2.0 to 13.1 years), patients with an early diagnosed ELI had significantly better clinical outcomes, compared with those with a late diagnosis, with regard to the MEPS (91.3 ± 8.7 versus 74.7 ± 15.3, p = 0.003), MWS (81.3 ± 16.5 versus 66.3 ± 17.6, p = 0.019), DASH score (12.5 ± 8.7 versus 45.3 ± 23.5, p = 0.001), VAS elbow pain score (0.7 ± 1.1 versus 3.3 ± 2.1, p = 0.001), and VAS wrist pain score (0.9 ± 1.2 versus 3.9 ± 1.7, p < 0.001). The ranges of motion of the elbow and wrist did not differ significantly between the early and late groups (p > 0.05). A significantly lower percentage of patients had complications or subsequent surgical procedures in the early than in the late group (38% [6 of 16] versus 93% [14 of 15], p < 0.001).
Early diagnosis of an ELI with temporary stabilization of the DRUJ leads to satisfactory clinical mid-term results, whereas late diagnosis of an ELI is associated with a deteriorated outcome.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在调查大量埃塞克斯-洛普雷斯蒂损伤（ELIs）的治疗结果，并比较早期诊断和晚期诊断的患者情况。
本研究纳入了31例ELI患者（平均年龄及标准差[SD]为46±10岁），这些患者至少随访了2年。根据ELI是在损伤当天（早期）还是晚期（桡骨头损伤后>4周）被诊断出来，将患者进行分组。早期诊断的ELI的急性治疗包括用克氏针临时稳定下尺桡关节（DRUJ），前臂旋后位固定6周。基于活动范围、梅奥肘关节功能评分（MEPS）、梅奥腕关节评分（MWS）、腕关节和肘关节疼痛的视觉模拟量表（VAS）评分以及上肢、肩部和手部功能障碍（DASH）评分来评估临床结果。
16例患者（52%；早期组）在损伤当天被诊断为ELI，15例（48%；晚期组）诊断较晚（平均7±7个月；范围1至24个月）。在平均随访5.3±3.0年（范围2.0至13.1年）后，早期诊断的ELI患者在MEPS（91.3±8.7对74.7±15.3，p = 0.003）、MWS（81.3±16.5对66.3±17.6，p = 0.019）、DASH评分（12.5±8.7对45.3±23.5，p = 0.001）、VAS肘关节疼痛评分（0.7±1.1对3.3±2.1，p = 0.001）和VAS腕关节疼痛评分（0.9±1.2对3.9±1.7，p < 0.001）方面的临床结果明显优于晚期诊断的患者。早期组和晚期组的肘关节和腕关节活动范围差异无统计学意义（p > 0.05）。早期组出现并发症或后续手术的患者比例明显低于晚期组（38%[16例中的6例]对93%[15例中的14例]，p < 0.001）。
早期诊断ELI并临时稳定DRUJ可带来满意的临床中期结果，而ELI的晚期诊断则与较差的结果相关。
治疗性III级。有关证据水平的完整描述，请参阅作者须知。
