O'Driscoll S W
Department of Orthopedics, Mayo Clinic, Rochester, Minnesota.
Hand Clin. 1994 Aug;10(3):405-15.
Elbow instability is a spectrum from subluxation to dislocation, with corresponding clinical and pathologic features and therapeutic implications. A classification that unifies these aspects is presented. Posterolateral rotational displacement of the ulna (with the radius) on the humerus appears to be the common mechanism. Acute dislocations can be reduced in supination and tested for valgus stability in pronation. Treatment is determined by the stability following reduction. When there are fractures, the principle is to fix the bones so that the only limitation is the ligaments and then to repair them if the elbow is not stable enough to permit early motion. The three prerequisites for stability of the ulnohumeral articulation are an intact joint surface, anterior medial collateral ligament, and ulnar part of the lateral collateral ligament. Recurrent instability is usually due to insufficiency of the ulnar part of the lateral collateral ligament complex, the lateral ulnar collateral ligament (LUCL), with attenuation of the other secondary soft tissue constraints on the lateral side. Reconstruction of the lateral ulnar collateral ligament typically corrects the problem. Chronic dislocations are treated by similar techniques after releasing contractures and resurfacing the joint with biologic tissue if it is irreversibly damaged.
肘关节不稳定是一个从半脱位到脱位的连续谱，具有相应的临床、病理特征及治疗意义。本文提出了一种统一这些方面的分类方法。尺骨（与桡骨一起）在肱骨上的后外侧旋转移位似乎是常见机制。急性脱位可在旋后位复位，并在旋前位检查外翻稳定性。治疗取决于复位后的稳定性。存在骨折时，原则是固定骨骼，使唯一的限制因素为韧带，若肘关节不够稳定而无法早期活动，则随后修复韧带。尺肱关节稳定的三个前提条件是关节面完整、前内侧副韧带以及外侧副韧带的尺侧部分。复发性不稳定通常是由于外侧副韧带复合体的尺侧部分即尺侧副韧带（LUCL）功能不全，同时外侧其他次要软组织限制因素也发生了衰减。尺侧副韧带重建通常可纠正该问题。慢性脱位在松解挛缩后采用类似技术治疗，若关节不可逆受损，则用生物组织对关节进行表面置换。
