Theisen Niklas, Ott Nadine, Leschinger Tim, Müller Lars Peter, Hackl Michael
Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
Oper Orthop Traumatol. 2024 Aug;36(3-4):180-187. doi: 10.1007/s00064-024-00850-0. Epub 2024 Jul 29.
Restoration of longitudinal forearm stability by reconstruction of the central band (CB) of the interosseous membrane (IOM) of the forearm.
Acute and chronic Essex-Lopresti lesions (EL) with longitudinal forearm instability.
Absolute: acute/subacute infection. Relative: severe complex regional pain syndrome (CRPS), bony deformity/bone loss, pronounced osteoarthritis of the elbow and wrist.
Ulnar approach with exposure of the ulna approximately 6 cm proximal to the ulnar styloid. Creation of a 3.5 mm drill hole from ulnar-distal to radial-proximal. A Fiberloop (Fa. Arthrex, Naples, FL, USA) is fixed to one end of the LARS (Ligament Advanced Reconstruction System, Fa. Corin Group, Cirencester, UK) in a whipstitch technique, is shuttled through the drill hole from radial to ulnar and fixed over a BicepsButton (Fa. Arthrex, Naples, FL, USA). Exposure of the radius through a modified Henry approach. A 3.5 mm drill hole is made from radial-proximal to ulnar-distal approximately 12 cm proximal to the radial styloid. The graft is shuttled from the ulnar to the radial incision directly on the palmar surface of the IOM and shortened to the required length. Another Fiberloop is used to perform a whipstitch on the free end of the LARS. The final fixation of the CB reconstruction is achieved by shuttling the Fiberloop sutures through the radial drill hole with fixation over a BicepsButton.
Short-term immobilization in a long arm cast with subsequent early functional treatment.
Mediocre to poor clinical results are reported in the literature for the treatment of chronic EL. Future research will tell whether the advanced surgical techniques with CB reconstruction will lead to better clinical outcomes.
通过重建前臂骨间膜（IOM）的中央束（CB）来恢复前臂的纵向稳定性。
伴有前臂纵向不稳定的急性和慢性埃塞克斯-洛普雷斯蒂损伤（EL）。
绝对禁忌症：急性/亚急性感染。相对禁忌症：严重的复杂性区域疼痛综合征（CRPS）、骨畸形/骨质流失、肘部和腕部明显的骨关节炎。
采用尺侧入路，在尺骨茎突近端约6厘米处暴露尺骨。从尺骨远端向桡骨近端钻一个3.5毫米的钻孔。用锁边缝合法将一个纤维环（美国佛罗里达州那不勒斯市Arthrex公司）固定在LARS（韧带高级重建系统，英国赛伦塞斯特市Corin集团）的一端，从桡骨向尺骨穿过钻孔并固定在一个二头肌纽扣（美国佛罗里达州那不勒斯市Arthrex公司）上。通过改良的亨利入路暴露桡骨。在桡骨茎突近端约12厘米处从桡骨近端向尺骨远端钻一个3.5毫米的钻孔。移植物在IOM掌面直接从尺侧切口穿梭至桡侧切口，并缩短至所需长度。用另一个纤维环在LARS的自由端进行锁边缝合。通过将纤维环缝线穿过桡侧钻孔并固定在一个二头肌纽扣上来完成CB重建的最终固定。
用长臂石膏短期固定，随后进行早期功能治疗。
文献报道慢性EL治疗临床效果一般至较差。未来的研究将表明CB重建的先进手术技术是否会带来更好的临床结果。
