[韧带肘关节脱位后增加初级缝合线“内支”]。

IF 1 4区 医学 Q3 ORTHOPEDICS
Valentin Rausch, Matthias Königshausen, Thomas A Schildhauer, Jan Geßmann
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引用次数: 0

摘要

目的:手术治疗的目的是对韧带脱位后不稳定肘关节进行初步稳定。适应症:韧带性肘关节脱位通常伴有肘关节周围肌肉组织和副韧带损伤。如果非手术治疗失败,即只有在固定> 90°时才能防止脱位,并且肘关节前旋或肘关节的主动肌肉定心在5-7天后失败,则需要手术治疗。禁忌症:单纯“内支”增强初级缝合的禁忌症通常是肘关节脱位、广泛软组织损伤和感染性肘关节关节炎的骨性损伤。手术技术:肘关节的增强初级缝合采用外侧(Kocher或Kaplan)和内侧(FCU劈开)入路进行。肘关节复位后,首先用高强度聚乙烯缝合线增强副韧带,并与另一种高强度聚乙烯增强缝合线一起固定在肱骨远端。然后使用缝合锚将伸肌和屈肌分别固定在内上髁和外侧上髁上。术后处理:术后处理的目的是肘关节的早期功能锻炼。肘关节置于肘关节支架中以避免内翻和外翻负荷。结果:2018年8月至2020年1月,共有12例不稳定韧带肘关节脱位患者接受了增强一期缝合治疗。平均随访14 ±12.7个月后,平均Mayo肘关节功能评分为98.5分,平均功能弧度为115°。没有患者报告复发性脱位或肘关节持续不稳定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

[Augmented primary sutures "internal bracing" following ligamentous elbow dislocation].

[Augmented primary sutures "internal bracing" following ligamentous elbow dislocation].

[Augmented primary sutures "internal bracing" following ligamentous elbow dislocation].

[Augmented primary sutures "internal bracing" following ligamentous elbow dislocation].

Objective: Aim of surgical treatment is the primary stabilization of the unstable elbow following a ligamentous elbow dislocation.

Indications: Ligamentous elbow dislocations are typically accompanied by injuries to the surrounding musculature and collateral ligaments of the elbow joint. Surgical treatment is indicated in case of failure of nonoperative therapy, i.e., when a dislocation can only be prevented in immobilization > 90° and pronation of the elbow or an active muscular centering of the elbow fails after 5-7 days.

Contraindications: Contraindications for a solely "internal bracing" augmented primary suture are generally in the case of accompanying bony injuries in elbow dislocations, extensive soft-tissue injuries, and septic arthritis of the elbow.

Surgical technique: The augmented primary suture of the elbow is performed using both a lateral (Kocher or Kaplan) and medial (FCU split) approach to the elbow. After reduction of the elbow, the collateral ligaments are first augmented with high-strength polyethylene suture and fixed in the distal humerus together with another high-strength polyethylene augmentation suture. The extensors and flexors are then fixed to the medial and lateral epicondyle, respectively, using suture anchors.

Postoperative management: The aim of the postoperative management is early functional exercise of the elbow. The elbow is placed in an elbow brace to avoid varus and valgus load.

Results: Between August 2018 and January 2020, a total of 12 patients were treated with an augmented primary suture following unstable ligamentous elbow dislocation. After a mean follow-up of 14 ± 12.7 months, the mean Mayo Elbow Performance Score was 98.5 points with a mean functional arc of 115°. None of the patients reported a recurrent dislocation or persistent instability of the elbow.

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来源期刊
CiteScore
2.10
自引率
0.00%
发文量
32
审稿时长
>12 weeks
期刊介绍: Orthopedics and Traumatology is directed toward all orthopedic surgeons, trauma-tologists, hand surgeons, specialists in sports injuries, orthopedics and rheumatology as well as gene-al surgeons who require access to reliable information on current operative methods to ensure the quality of patient advice, preoperative planning, and postoperative care. The journal presents established and new operative procedures in uniformly structured and extensively illustrated contributions. All aspects are presented step-by-step from indications, contraindications, patient education, and preparation of the operation right through to postoperative care. The advantages and disadvantages, possible complications, deficiencies and risks of the methods as well as significant results with their evaluation criteria are discussed. To allow the reader to assess the outcome, results are detailed and based on internationally recognized scoring systems. Orthopedics and Traumatology facilitates effective advancement and further education for all those active in both special and conservative fields of orthopedics, traumatology, and general surgery, offers sup-port for therapeutic decision-making, and provides – more than 30 years after its first publication – constantly expanding and up-to-date teaching on operative techniques.
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