Regel G, Weinberg A M, Seekamp A, Blauth M, Tscherne H
Unfallchirurgische Klinik, Medizinische Hochschule Hannover.
Orthopade. 1997 Dec;26(12):1020-9.
The complex injury is characterized by a fracture and/or dislocation of the elbow in association with a serial injury of the upper extremity, or a severe soft tissue trauma, or a prolonged ischemia caused by vascular injury or compartment syndrome. They are defined as complex injuries because their treatment differs from that of a simple fracture implying that standardized concepts usually cannot be employed. The results of primary treatment show a high rate of complications. They are accompanied by functional deficits including pseudarthrosis and ankylosis. As a consequence, ulnar neuropathy may occur. Inadequate treatment leads to delayed rehabilitation and several secondary operations. The main goal points at the reconstruction of the elbow joint to restore function. Therefore, the logistical pathway of individual therapy is the key for success. The operation has to include fracture stabilisation of all injuries of the upper extremity. Only stable osteosynthesis makes early mobilisation possible. Transfixation of the elbow joint should be reserved for exceptional cases. The principals of AO have proven to be practical both for the distal humerus and the proximal forearm. Successful reconstruction of the elbow joint often demands extended approaches. ORIF of the proximal ulna can be achieved by indirect reposition techniques. Dynamic stabilisation should be established by conservation of the radial head and coronoid process. For treatment of soft tissue injury it is necessary to undertake local reconstructive measures. Operative treatment is widely indicated for forearm compartment syndrome. Diagnosis and therapy of possible accompanying vascular injury should be made early to avoid prolonged ischemia. Operative treatment of nerve injury is only indicated in case of sharp dissection of the nerve. Otherwise the reconstruction should be performed, but not earlier than three months. Rehabilitation outcome depends on primary therapy. Sufficient functional results are only achieved after early mobilisation and intensive physiotherapy. If necessary, arthrolysis is planned early and combined with removal of implants at 6 months post injury.
复杂损伤的特征是肘部骨折和/或脱位，伴有上肢的连续性损伤、严重软组织创伤，或由血管损伤或骨筋膜室综合征导致的长时间缺血。它们被定义为复杂损伤，因为其治疗方法与简单骨折不同，这意味着通常不能采用标准化概念。一期治疗结果显示并发症发生率很高。它们伴有包括假关节和关节强直在内的功能缺陷。因此，可能会发生尺神经病变。治疗不当会导致康复延迟和多次二次手术。主要目标是重建肘关节以恢复功能。因此，个体化治疗的合理路径是成功的关键。手术必须包括稳定上肢所有损伤的骨折。只有稳定的骨固定才能实现早期活动。肘关节固定应仅用于特殊情况。AO原则已被证明对肱骨远端和前臂近端都很实用。肘关节的成功重建通常需要广泛的手术入路。尺骨近端的切开复位内固定可以通过间接复位技术实现。应通过保留桡骨头和冠突来建立动态稳定。对于软组织损伤的治疗，有必要采取局部重建措施。对于前臂骨筋膜室综合征，广泛建议进行手术治疗。应尽早对可能伴发的血管损伤进行诊断和治疗，以避免长时间缺血。神经损伤的手术治疗仅适用于神经锐性离断的情况。否则应进行重建，但不早于受伤后三个月。康复结果取决于一期治疗。只有在早期活动和强化物理治疗后才能取得足够的功能结果。如有必要，应尽早计划关节松解，并在受伤后6个月联合取出植入物。
