From the Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN.
J Am Acad Orthop Surg. 2018 Dec 1;26(23):e490-e495. doi: 10.5435/JAAOS-D-17-00110.
The purposes of this study were to evaluate the radiographic anatomy of the elbow and try to determine its possible relation to elbow flexion contracture in patients with obstetric brachial plexus injury (OBPI).
All patients with a history of OBPI with elbow flexion contracture who were evaluated clinically and radiographically were included in the study. A review was performed to include serial elbow examinations and previous treatment. Radiographs of the elbow were examined for the presence of bony abnormalities as a potential cause of elbow flexion contracture or the presence of progressive arthritic changes over time.
Fifty-nine patients with a history of OBPI with elbow flexion contracture were included in the study. Of them, 53 had normal bony architecture, 2 had mild radial head subluxation, and 4 had chronic anterior radial head dislocations. At a mean age at final clinical follow-up of 21 years (range, 7 to 83 years), only 7% of patients had pain localized to their elbow. There were only three patients with elbow arthritis, including two of the four with radial head dislocations.
In the absence of a radial head dislocation, most elbow joints do not seem to undergo abnormal anatomic bony changes in patients with OBPI and flexion contractures.
Level IV (retrospective case series).
本研究旨在评估肘部的影像学解剖结构，并试图确定其与产伤性臂丛神经损伤（OBPI）患者肘部屈曲挛缩的可能关系。
本研究纳入了所有临床和影像学评估为肘部屈曲挛缩且有 OBPI 病史的患者。对连续的肘部检查和既往治疗进行了回顾。对肘部 X 线片进行了检查，以确定是否存在可能导致肘部屈曲挛缩的骨畸形，或是否存在随时间推移而进展的进行性关节炎改变。
本研究纳入了 59 例有 OBPI 病史且伴肘部屈曲挛缩的患者。其中 53 例患者的骨结构正常，2 例患者存在轻度桡骨头半脱位，4 例患者存在慢性桡骨头前脱位。在最终临床随访的平均年龄为 21 岁（范围为 7 岁至 83 岁）时，仅有 7%的患者肘部疼痛局限。仅有 3 例患者发生肘关节炎，其中包括 4 例桡骨头脱位患者中的 2 例。
在没有桡骨头脱位的情况下，大多数 OBPI 患者的肘部关节似乎不会发生异常的解剖骨改变，且伴有屈曲挛缩。
IV 级（回顾性病例系列研究）。
