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中华肩肘外科电子杂志 ›› 2023, Vol. 11 ›› Issue (01) : 71 -74. doi: 10.3877/cma.j.issn.2095-5790.2023.01.011

所属专题: 经典病例

病例报告

同侧鹰嘴带肱三头肌腱瓣重建冠突及前侧关节囊治疗陈旧肘关节后脱位病例报道一例
周世成1, 王彦冰1, 刘贺1, 任广凯1, 吴丹凯1,()   
  1. 1. 130041 长春,吉林大学第二医院创伤骨科
  • 收稿日期:2022-09-12 出版日期:2023-02-05
  • 通信作者: 吴丹凯
  • Received:2022-09-12 Published:2023-02-05
引用本文:

周世成, 王彦冰, 刘贺, 任广凯, 吴丹凯. 同侧鹰嘴带肱三头肌腱瓣重建冠突及前侧关节囊治疗陈旧肘关节后脱位病例报道一例[J]. 中华肩肘外科电子杂志, 2023, 11(01): 71-74.

尺骨冠突是肘关节的重要稳定结构,其缺失可导致急性或慢性的肘关节不稳、半脱位或复发性脱位,进而迅速进展成创伤性关节炎[1]。当冠突骨折治疗失败出现关节不稳或活动受限时,重建冠突是必要的手段。当冠突重建后依然存在关节不稳时,应考虑同期对维持肘关节稳定的软组织结构进行修复。

图1 患肢肘关节损伤急诊影像学检查 图A:X线片示肘关节后脱位;图B:三维CT冠突游离骨块;图C:患侧肘关节后脱位,桡骨头、尺骨冠突骨折;图D:桡骨头游离骨块
图2 术后正侧位X线片示桡骨头骨折复位螺钉内固定、尺骨鹰嘴截骨双钢板、克氏针内固定,肱骨内外髁、尺骨冠突基底骨锚影(图A-B);术后40 d正位X线片示桡骨头复位丢失(图C);术后40 d侧位X线片示肘关节半脱位、鹰嘴窝处异位骨化形成(图D)注:箭头标识示鹰嘴截骨线
图3 初次手术术后40 d肘关节功能受限 图A:最大屈曲55°;图B:最大伸直0°;图C:肘关节后正中入路手术皮肤切口长约20 cm
图4 三维CT示桡骨头复位丢失,尺骨冠凸外侧尖部缺损(图A-B);尺骨鹰嘴2枚微钢板内固定(图C);肘关节后脱位(图D)
图5 患者诊疗流程图
图6 肘关节损伤部位术中外像 图A:桡骨头复位丢失;图B:肱骨小头后半部分缺损;图C:冠突尖部及外侧缘缺损
图7 带肱三头肌腱鹰嘴尖重建冠突术中外像 图A:冠状位截取高1 cm鹰嘴尖部并切取与移植骨块紧密连接的肱三头肌腱前侧长2.0 cm、宽2.0 cm、厚2.0 mm的腱性结构;图B:与体外用2根韧带缝合线对切取的韧带进行编织缝合;图C:骨凿修平冠突缺损部分;图D:修整移植骨外形使其匹配冠突基底
图8 前侧关节囊重建术中外像 图A:将取自鹰嘴尖部的自体骨植入残留冠突基底部;图B:克氏针固定移植骨块;图C:桡骨头骨折解剖复位微钢板内固定;图D:重建前侧关节囊,安装同轴外固定架
图9 术后X线片 图A-B:术后正侧位X线片示骨折复位满意,冠突高度恢复;图C-D:去除同轴外固定架后影像学显示肱尺关节对位良好,无脱位趋势
图10 术后1年与术前CT断层对比 图A-B:术后1年复查X线片示轻度骨性关节炎改变;图C-D:术前CT示冠突尖部外侧骨缺损;图E-F:术后CT示肱尺关节面对位良好,图E与图C对比测量得冠突高度恢复9.8 mm(约占冠突整体高度37.3%)注:图C-D箭头标识示冠突尖部内侧缺损;图E箭头标识示初次手术鹰嘴截骨线
图11 翻修手术术后13个月功能评估:患侧肘关节功能 图A:屈曲140°;图B:伸直0°;图C:旋后40°;图D:旋前80°;图E:肘关节外侧手术切口
图12 内固定物取出术后正(图A)、侧(图B)位X线片示移植骨块骨性愈合肱尺关节面对位良好
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