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[肘关节后内侧旋转不稳定的研究进展]

[Research progress of posteromedial rotatory instability of the elbow].

作者信息

Long Nengji, He Shukun, Wu Shizhou, Huang Fuguo

机构信息

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Apr 15;32(4):505-510. doi: 10.7507/1002-1892.201710101.

Abstract

OBJECTIVE

To summarize the research progress in posteromedial rotatory instability (PMRI) of the elbow joint.

METHODS

The recent researches about the management of PMRI of the elbow joint from the aspects of pathological anatomy, biomechanics, diagnosis, and therapy were analyzed and summarized.

RESULTS

The most important factors related to PMRI of the elbow joint are lateral collateral ligament complex (LCLC) lesion, posterior bundle of the medial collateral ligament complex (MCLC) lesion, and anteromedial coronoid fracture. Clinical physical examination include varus and valgus stress test of the elbow joint. X-ray examination, computed tomography, particularly three-dimensional reconstruction, are particularly useful to diagnose the fracture. Also MRI, arthroscopy, and dynamic ultrasound can assistantly evaluate the affiliated injury of the parenchyma. It is important to repair and reconstruct LCLC and MCLC and fix coronoid process fracture for recovering stability of the elbow joint. There are such ways to repair ligament injury as repairation and functional reconstruction, which include direct suturation, borehole repairation, wire anchor repairation, and transplantation repairation . The methods for fixation of coronal fracture include screw fixation, plate fixation, unabsorbable suture fixation, and arthroscopy technology.

CONCLUSION

It is crucial that recovering the stability of the elbow joint and early functional exercise for the treatment of PMRI. Individual treatment is favorable to protect soft tissue, reduce surgical complications, and improve the functional recovery and the quality of life.

摘要

目的

总结肘关节后内侧旋转不稳定(PMRI)的研究进展。

方法

从病理解剖、生物力学、诊断及治疗等方面,对近期肘关节PMRI的治疗研究进行分析总结。

结果

与肘关节PMRI相关的最重要因素为外侧副韧带复合体(LCLC)损伤、内侧副韧带复合体(MCLC)后束损伤及前内侧冠状突骨折。临床体格检查包括肘关节的内翻和外翻应力试验。X线检查、计算机断层扫描,尤其是三维重建,对骨折诊断特别有用。此外,磁共振成像、关节镜检查及动态超声可辅助评估实质附属损伤。修复和重建LCLC及MCLC并固定冠状突骨折对于恢复肘关节稳定性很重要。修复韧带损伤的方法有修复和功能重建,包括直接缝合、钻孔修复、钢丝锚钉修复及移植修复。冠状突骨折的固定方法包括螺钉固定、钢板固定、不可吸收缝线固定及关节镜技术。

结论

恢复肘关节稳定性及早期功能锻炼对PMRI的治疗至关重要。个体化治疗有利于保护软组织、减少手术并发症并提高功能恢复及生活质量。

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