Abehsera Eric, Guerre Elvire, Duriez Pauline, El Rafei Mazen, Fontaine Christian, Chantelot Christophe
Service de Chirurgie Orthopédique et Traumatologique, CHRU de Lille, Avenue du Professeur Emile Laine, Lille, France.
Service d'Orthopédie B, Chirurgie de la Main et Membre Supérieur, CHRU de Lille, Avenue du Professeur Emile Laine, Lille, France.
Eur J Orthop Surg Traumatol. 2019 May;29(4):785-792. doi: 10.1007/s00590-019-02374-x. Epub 2019 Jan 16.
Elbow dislocation can lead to instability and stiffness of the elbow. The main goal of this study was to list the initial elbow ligaments injuries caused by simple posterolateral elbow dislocations. The secondary goals were to assess ligament healing 2 months after the initial dislocation, to research a correlation between ligaments injuries and clinical course, and to search for predictive factors of instability.
Patients who had simple posterolateral elbow dislocation for the first time between January 2015 and May 2016 were included. Each patient had an MRI scan of their traumatised elbow on the day of the dislocation and then again 2 months later. The assessment was performed thanks to a clinical examination and calculation of functional recovery scores. The Mann-Whitney U test was used to research a correlation between the healing of ligaments injuries and clinical course.
Twenty-five patients were included in the study. The initial MRI scans showed 70% and 54% ligament rupture, respectively, for the anterior band (ant MCL) and the posterior band (post MCL) of the medial collateral ligament (MCL), as well as 79% for the ulnar (ULCL) and 50% for the radial (RLCL) lateral collateral ligaments. The healing rate 2 months after dislocation was fairly low from 18% for the ULCL up to 41% for the anterior band of the MCL. No correlation was found between the ligament healing noticeable on MRI scans and clinical course. No elbow instability was diagnosed during the 4-month follow-up.
Elbow dislocation is particularly damaging for ligaments. There is no predominance on medial or lateral ligament for rupture. The low healing rate 2 months after the initial dislocation could be explained by performing a follow-up MRI scan too early.
肘关节脱位可导致肘关节不稳定和僵硬。本研究的主要目的是列出单纯后外侧肘关节脱位导致的初始肘关节韧带损伤。次要目的是评估初次脱位2个月后韧带的愈合情况,研究韧带损伤与临床病程之间的相关性,并寻找不稳定的预测因素。
纳入2015年1月至2016年5月首次发生单纯后外侧肘关节脱位的患者。每位患者在脱位当天对受伤的肘关节进行磁共振成像(MRI)扫描,2个月后再次进行扫描。通过临床检查和功能恢复评分计算进行评估。采用曼-惠特尼U检验研究韧带损伤愈合与临床病程之间的相关性。
25例患者纳入本研究。初始MRI扫描显示,内侧副韧带(MCL)前束(ant MCL)和后束(post MCL)的韧带断裂率分别为70%和54%,尺侧副韧带(ULCL)为79%,桡侧副韧带(RLCL)为50%。脱位2个月后的愈合率相当低,从尺侧副韧带的18%到内侧副韧带前束的41%不等。MRI扫描显示的韧带愈合与临床病程之间未发现相关性。在4个月的随访期间未诊断出肘关节不稳定。
肘关节脱位对韧带的损伤尤为严重。内侧或外侧韧带断裂无明显优势。初次脱位2个月后愈合率低可能是因为过早进行随访MRI扫描。