【摘要】 目的 探讨在肘关节韧带损伤治疗中,应用超声检查判断肘关节稳定性的可靠性和临床意义。方法 选自2014年1月至2017年12月复旦大学附属华山医院收治的23例肘关节损伤病例,其中男11例、女12例,年龄15 ～ 68岁,平均年龄41.5岁。根据超声检查侧副韧带完整性作为依据,将术中应力实验结果作为治疗参考标准,以此决定肘关节韧带损伤的治疗方式。手术均采用韧带探查锚钉固定重建缝合术。随访肘关节功能评分和骨折愈合情况。结果 超声检查中发现14例患者内、外侧副韧带均撕裂;8例患者为外侧副韧带损伤,其中5例完全撕裂;1例患者为内侧副韧带损伤。以麻醉下应力实验结果作为金标准,其敏感性为97%,特异性为70%。采用Mayo肘关节功能评分系统,结果为优17例、良3例、中3例,优良率为87%。结论 对于肘关节侧副韧带损伤后稳定性的判断,超声检查是一项价廉、高效的检查方式,也有助于临床医生在术中结合应力实验结果对肘关节侧副韧带损伤处理作出判断。更多还原

【Abstract】 Background Traumatic instability caused by elbow dislocation is one of the most common upper limb injuries in clinic.Traumatic dislocation is often accompanied by injury of articular capsule and ligament,as well as bone structural injury,such as radial capitulum fracture,ulnar coronoid process fracture,humeral condylar fracture,etc.The injury of medial and lateral collateral ligaments is often the cause of elbow instability.For the treatment of elbow dislocation,plaster cast after manual reduction is often used in clinic,but how to evaluate the stability of elbow joint after reduction is still one of the clinical difficulties.At present,there is no convincing physical examination method to prove the function or stability of elbow joint.Because of the influence of pain,it is difficult to conduct stress tests to determine the stability of ligaments.Ultrasound is a commonly used method to evaluate the condition of ligaments in clinic.Ultrasound is used to check the integrity of the medial and lateral collateral ligaments of elbow,and stress test under anesthesia is used to judge the stability of elbow,so as to guide the choice of treatment.Objective To investigate the reliability and clinical significance of ultrasonography in the diagnosis of elbow stability.Methods From January 2014 to December 2017,23 cases (11 males and 12 females) of lateral collateral ligament injury of elbow were treated in our hospital.The ages ranged from 15 to 68 years with an average of 41.5 years.According to the integrity of collateral ligament examined by high-frequency ultrasound,combined with the results of intraoperative stress test,the treatment of elbow ligament injury is decided.The ligament exploration anchor fixation and reconstruction suture were used in the operation,and the elbow function scores and fracture healing were followed up.Results Ultrasound examination revealed that 14 patients had tear of medial and lateral collateral ligaments,and 8 patients had lateral collateral ligament injury with 5 cases of complete interruption and 1 cases of medial collateral ligament injury.The results of the stability test of the collateral ligament of the elbow joint under intraoperative anesthesia were used as a reference standard,and the sensitivity and specificity were 97% and 70%.Mayo elbow function scoring system were used,and there were 17 excellent cases,3 good cases,3 moderate cases.The excellent and good rate was 87%.Conclusions Ultrasound is an inexpensive,safe and effective way to judge the stability of the collateral ligament in elbow injury.It is also helpful for clinicians to make a clear judgment on the management of collateral ligament injury of elbow joint by combining the results of intraoperative stress test.更多还原