Niu Xiaofeng, Huang Xijun, Xu Yinfeng, Yi Jianhua, Hu Jun, Xiao Liangbao
Department of Upper Extremity Orthopedics, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Ann Transl Med. 2023 Feb 15;11(3):154. doi: 10.21037/atm-22-6598.
Combined injuries of ipsilateral wrist and elbow joints are rare in clinical practice, characterized by multiple joint dislocations or/and fractures and varying manifestations. As there are still no clinical guidelines and no consensus on the standard treatment, this study aimed to explore the surgical intervention and complications of this kind of combined injuries.
This retrospective study was conducted in a single center. A total of 13 patients with acute combined injuries of the ipsilateral wrist and elbow joints receiving surgical treatment from August 2013 to May 2016 were retrospectively analyzed. The fracture and joint instability and structural damages were repaired and reconstructed.
All 13 patients were followed up for a mean duration of 17 months (range: 14 to 22 months). The X-ray films showed good fracture reduction and joint alignment, no fixation failure, re-displacement, bone nonunion, or ischemic necrosis in all cases. According to the Mayo Elbow Performance Score (MEPS), the excellent and good rate of joint function was 84.6%. According to the Mayo Modified Wrist Score (MMWS), the excellent and good rate of joint function was 76.9%. There were no significant restrictions on elbow and wrist movements. The disabilities of the arm, shoulder, and hand (DASH) score was excellent, with an average of 18.5 points.
The key to intervention of combined injuries of the wrist and elbow is to identify the types of injuries and conduct an overall assessment to determine the appropriate surgical methods. Early surgical intervention and rehabilitation exercise are the main principles for the treatment.
同侧腕关节和肘关节联合损伤在临床实践中较为罕见，其特点是多关节脱位或/和骨折，表现各异。由于目前尚无临床指南，对于标准治疗也未达成共识，本研究旨在探讨此类联合损伤的手术干预及并发症。
本回顾性研究在单一中心进行。对2013年8月至2016年5月期间接受手术治疗的13例同侧腕关节和肘关节急性联合损伤患者进行回顾性分析。对骨折、关节不稳定及结构损伤进行修复和重建。
13例患者均获随访，平均随访时间为17个月（范围：14至22个月）。X线片显示骨折复位良好，关节对位良好，所有病例均未出现内固定失败、再移位、骨不连或缺血性坏死。根据梅奥肘关节功能评分（MEPS），关节功能优良率为84.6%。根据梅奥改良腕关节评分（MMWS），关节功能优良率为76.9%。肘关节和腕关节活动无明显受限。上肢、肩部和手部功能障碍（DASH）评分优良，平均为18.5分。
腕关节和肘关节联合损伤干预的关键在于明确损伤类型并进行全面评估，以确定合适的手术方法。早期手术干预和康复锻炼是治疗的主要原则。
