Radial Head Fractures with Acute Distal Radioulnar Dislocation: Essex‐Lopresti Revisited
Radial Head Fractures with Acute Distal Radioulnar Dislocation: Essex‐Lopresti Revisited
复制标题
桡骨头骨折伴急性远端桡尺脱位：Essex-Lopresti 再访
DOI：
--
复制
发表时间：
1988
影响因子：
4.2
通讯作者：
J. Jupiter
中科院分区：
文献类型：
--
作者：
G. Edwards;J. Jupiter
7例移位的成人桡骨小头骨折合并远端尺桡关节脱位。由于肘部和腕部都失去了对桡骨的支持，因此发生了从5 mm到10 mm的近端移位。对不同类型的骨折进行分类，以指定恢复桡骨长度以防止慢性手腕疼痛和僵硬的最佳方法。I型骨折有大的移位的桡骨小头骨折，粉碎性很小或没有粉碎性骨折，可以进行不完整内固定。II型骨折有严重粉碎性骨折，需行桡骨头切除和假体置换术。III型为陈旧性损伤，采用尺骨短缩和人工桡骨头置换术治疗，并伴有不可复性的近端移位。其中I型骨折3例，II型骨折2例，III型骨折2例。治疗结果：优3级；良2级；可1级；差1级。这三个优秀的结果是在损伤后一周内恢复了桡骨长度的患者。当最终手术推迟4至10周时，其余4名患者的结果并不理想。结果不佳的是，一名患者仅接受了放射头切除术，并拒绝进一步手术。建议包括对所有移位的桡骨头骨折患者进行仔细的临床和X线片检查。采用解剖复位和坚固内固定的方法保存桡骨头是首选方法，但在广泛粉碎性骨折的情况下，可能需要行桡骨头置换。单纯的桡骨小头切除，虽然是禁忌症，但可以通过尺骨缩短术和假体置换来重建。
Seven adults with displaced radial head fractures had concurrent dislocation of the distal radioulnar joint. Because support of the radius was lost at both the elbow and wrist, proximal migration of the radius from 5 to 10 mm occurred. Different types of fractures were classified to designate the best method of restoring radial length to prevent chronic wrist pain and stiffness. Type I fractures had large displaced radial head fragments with minimal or no comminution and amenable to in-terfragmentary fixation. Type II fractures had severe comminution requiring radial head excision and prosthetic replacement. Type III were old injuries with irreducible proximal migration of the radius managed by ulnar shortening and radial head prosthetic replacement. There were three Type I, two Type II, and two Type III fractures. Results of treatment were graded as 3, excellent; 2, good; 1, fair; and 1, poor. The three excellent results were in patients in which restoration of radial length was achieved within one week of injury. Suboptimal results occurred in the remaining four patients when definitive surgery was delayed four to ten weeks. The poor result was in a patient treated only by radial head excision and who refused further surgery. Recommendations include meticulous clinical and roentgenographic examination of the distal radioulnar joint in all patients with displaced radial head fractures. Preservation of the radial head with anatomic reduction and rigid internal fixation is preferred, but radial head replacement may be necessary in cases with extensive comminution. Radial head excision alone, though contraindicated, may be restructured by ulnar shortening and radial head prosthetic replacement.