Pari Carlotta, Puzzo Agnese, Paderni Stefania, Belluati Alberto
Orthopaedic and Traumatology Department, Hospital Santa Maria delle Croci, Ravenna, Italy.
Acta Biomed. 2018 Dec 19;90(1-S):154-157. doi: 10.23750/abm.v90i1-S.8010.
The annular ligament has a crucial role in the radial head stability and it is critical to the proper functioning of the proximal radio-capitellar joint. Its chronic injury may lead to radial head instability, elbow pain with decrease in motion and valgus deformity. Method: We present the case of a 53-year-old heavy laborer who reported a complex trauma of the right upper limb with a Floating Elbow Injury, associated to an open Monteggia fracture-dislocation. One month later, despite the definitive fixation with plates of both the forearm and the supracondylar fractures, X-rays showed the persistence of the radial head dislocation. A triceps autograft reconstruction for treating the chronic radial head dislocation, as described in literature, was not indicated in our patient, due to the recent surgery at the distal humerus site. Thus, it was decided to proceed to allograft reconstruction using a peroneal tendon from a cadaveric donor, fixed by modified Bell-Tawse Technique. Results: Two years after the surgery, x-rays showed the complete fractures' healing; however a radial head notching was found. Conclusions: Allograft reconstruction of the annular ligament deserves to be considered as an adequate technique, whenever the surrounding soft tissues are critically compromised. In literature, the radial head notching complication is reported to be up to 36 %, and it may be related to the surgical technique, regardless of the graft used.
环状韧带在桡骨头稳定性方面起着关键作用，对近端桡尺关节的正常功能至关重要。其慢性损伤可能导致桡骨头不稳定、肘部疼痛伴活动度降低以及外翻畸形。方法：我们报告一例53岁的重体力劳动者，其右上肢出现复杂创伤，伴有浮肘损伤，并伴有开放性孟氏骨折脱位。一个月后，尽管对前臂骨折和髁上骨折均使用钢板进行了确定性固定，但X线显示桡骨头脱位持续存在。由于患者近期在肱骨远端部位进行了手术，按照文献所述，用于治疗慢性桡骨头脱位的肱三头肌自体移植重建手术并不适用于我们的患者。因此，决定采用尸体供体的腓骨肌腱进行同种异体移植重建，并采用改良的贝尔 - 陶斯技术进行固定。结果：术后两年，X线显示骨折完全愈合；然而，发现有桡骨头切迹。结论：每当周围软组织受到严重损伤时，环状韧带的同种异体移植重建值得被视为一种合适的技术。在文献中，桡骨头切迹并发症的报道高达36%，并且它可能与手术技术有关，与所使用的移植物无关。
