摘要
目的探讨Essex—Lopresti损伤合并桡骨远端关节内骨折的手术方法和治疗效果。方法回顾性分析2005年1月至2014年1月收治的8例Essex．Lopresti损伤合并桡骨远端关节内骨折患者资料，男6例，女2例；年龄19～48岁，平均35．7岁。桡骨头骨折Mason—Johnston分型：Ⅱ型5例，Ⅲ型1例，Ⅳ型2例；桡骨远端骨折AO分型：C1型4例，c2型2例，c3型2例。所有患者一期恢复桡骨长度、解剖复位桡骨关节面、复位并稳定下尺桡关节。末次随访时记录肘关节、前臂和腕关节活动范围、肘关节Mayo标准评分（MEPS）和Cooney改良的Green—O’Brien腕关节功能评分。结果8例患者术后获13～36个月（平均20．6个月）随访。骨折愈合时间为6～10周（平均7．5周）。末次随访时肘关节屈曲一伸直活动范围95。～155。（平均120．8。）；前臂旋前一旋后活动范围85。～145。（平均120．6。）；腕关节屈曲一伸直活动范围85。～135。（平均125．5。）。末次随访时肘关节功能按照MEPS评分标准：优5例，良2例，可1例；腕关节功能按照Cooney改良的Green—O’Brien腕关节功能评分标准：优5例，良1例，可2例。无一例患者发生感染、骨不连及内固定失效。结论Essex—Lopresti损伤合并桡骨远端关节内骨折易漏诊、误诊；一期恢复桡骨长度、解剖复位桡骨关节面、复位并稳定下尺桡关节的治疗可以取得良好疗效。
Objective To explore the surgical treatment of Essex-Lopresti lesion combined with in- traarticular fracture of distal radius. Methods From January 2005 to January 2014, we treated 8 patients with Essex-Lopresti lesion with intraarticular fractm＇e of distal radius. They were 6 men and 2 women, 19 to 48 years of age （average, 35.7 years）. According to the Mason-Johnston classification, there were 5 cases of type II, one of type m and 2 of type IV. By AO classification, there were 4 cases of type C1, 2 of type C2 and 2 of type C3. All patients received one stage operation to restore the radial length, anatomically reduce the articular surface of the radius, and reduce and stabilize the distal radioulnar joint. At the final follow-ups, the ranges of motion of the elbow, forearm, and wrist, Mayo Elbow Performance Score （MEPS） of the elbow, and the modified Green-O＇Brien score of the wrist were recorded. Results All the patients were available for a mean follow-up of 20.6 months （range, from 13 to 36 months） . Fractures healed within an average duration of 7.5 weeks （range, from 6 to 10 weeks） . At the final follow-ups, the elbow flexion and extension ranged from 95° to 155° （average, 120. 8°）, the forearm pronation and supination ranged from 85° to 145° （average, 120. 6°）, and the wrist flexion and extension ranged fi＇om 85° to 135° （average, 125.5°）. At the final follow-ups, the MEPS was excellent in 5 cases, good in 2, and fair in one. Tile modified Green＇Brien wrist performance score was ex- cellent in 5 eases, good in one, and fair in 2. No deep infection, nonunion or loosening of the internal fixator happened. Conclusions Essex-Lopresti lesion combined with intraarticular fracture of distal radius is likely misdiagnosed. Primary restoration of the length of distal radius, anatomical reduction of the articular surface of radius, and reduction and stabilization of the distal radioulnar joint can achieve good curative effects.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2016年第4期341-345,共5页
Chinese Journal of Orthopaedic Trauma
