自体骨移植重建伴顽固性肘关节脱位的巨大冠突缺损

薛依青, 陆九州, 李舒琳, 杨康绮, 徐建光

doi:10.13418/j.issn.1001-165x.2025.4.03

中国临床解剖学杂志 >

2025 , Vol. 43 >Issue 4: 379 - 386

DOI: https://doi.org/10.13418/j.issn.1001-165x.2025.4.03

肘关节运动损伤诊疗策略

自体骨移植重建伴顽固性肘关节脱位的巨大冠突缺损

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1.复旦大学附属华山医院手外科，上海 210040； 2.卫健委肢体功能重建重点实验室，上海 200032； 3.上海市周围神经显微外科重点实验室，上海 200032； 4.上海市手外科研究所，上海 200040； 5.复旦大学手外科研究所，上海 200040； 6.上海中医药大学康复医学院，上海 200102

薛依青（1998-），女，住院医师，研究方向：肘、腕、小关节疾病及其微创治疗，E-mail: xueyiqing98@foxmail.com

陆九州，博士，主任医师，E-mail: lujiuzhou@hotmail.com

收稿日期: 2025-06-19

网络出版日期: 2025-08-04

基金资助

上海市临床重点专科（shslczdzk05601）；上海市周围神经显微外科重点实验室（20DZ2270200）；关节解剖重建结合牵引成形技术提高手部小关节骨折治疗有效性的研究（20Y11912800）

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Reconstruction of massive coronoid defects associated with persistent elbow dislocation using autologous bone grafts

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1. Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 210040, China; 2. NHC Key Laboratory of Limbs Reconstruction, Shanghai 200032, China; 3. Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200032, China; 4. Institute of Hand Surgery, Shanghai 200040, China; 5. Institute of Hand Surgery, Fudan University, Shanghai 200040, China; 6. School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 200102, China

Received date: 2025-06-19

Online published: 2025-08-04

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摘要

目的探讨使用自体髂骨及桡骨头作移植物重建伴顽固性肘关节脱位的巨大冠突缺损，以恢复关节稳定性的临床疗效。方法回顾性分析采用自体髂骨或桡骨头移植物重建严重冠突缺损的6例患者的临床疗效。患者平均年龄36.2岁（28~57岁）。所有患者均因创伤导致严重冠突缺损伴陈旧的顽固性肘关节脱位，存在关节面磨损、塌陷及创伤性关节炎表现。结果 6例患者从受伤至重建手术平均时间间隔为26.8月（11~60月）。其中，5例患者取自体髂骨作移植物，1例取自体桡骨头作移植物。手术同期，2例接受桡骨头置换，2例采用Box-loop法重建侧副韧带，1例重建外侧副韧带。平均随访时间为26.5月（1~88月）。术后复查CT显示，术后超过3月的5例患者均实现骨性愈合，1例出现移植物吸收。5例患者术后仍遗留一定程度的肘关节僵硬；其中3例2期接受肘关节镜松解手术，2例功能恢复较为满意。6例患者的梅奥肘关节功能评分术后均较术前显著改善。结论采用自体髂骨及桡骨头移植物对伴顽固性肘关节脱位的冠突大面积缺损进行重建，能够获得确切的骨性愈合及关节复位并长期维持；结合2期关节镜松解手术，能使患者肘关节功能满足日常生活需求，避免关节置换，改善患者预后。

关键词： 冠突缺损; ; ; 冠突重建; ; ; 自体骨移植; ; ; 关节脱位

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薛依青, 陆九州, 李舒琳, 杨康绮, 徐建光 . 自体骨移植重建伴顽固性肘关节脱位的巨大冠突缺损[J]. 中国临床解剖学杂志, 2025 , 43(4) : 379 -386 . DOI: 10.13418/j.issn.1001-165x.2025.4.03

Abstract

Objective To evaluate the clinical efficacy of using autologous iliac bone and radial head grafts for the reconstruction of massive coronoid defects associated with persistent elbow dislocation to restore joint stability. Methods A retrospective analysis was conducted to evaluate the clinical outcomes of 6 patients who underwent reconstruction of severe coronoid defects using autologous iliac bone or radial head grafts. The patients had an average age of 36.2 years (28-57 years). All cases involved severe post-traumatic coronoid defects with chronic elbow dislocations, characterized by significant articular surface damage, collapse, and severe post-traumatic arthritis. Results The average interval between injury and reconstructive surgery for patients was 26.8 months (11-60 months). 5 patients received autologous iliac bone grafts, and one patient received an autologous radial head graft. Among them, 2 patients simultaneously underwent radial head replacement, 2 underwent Box-loop reconstruction of the collateral ligaments, and one underwent lateral collateral ligament reconstruction. The average follow-up duration was 26.5 months (1-88 months). 5 patients who were followed for more than 3 months, have achieved bony union according to CT scan. One case exhibited graft absorption. Residual elbow stiffness was observed in 5 patients postoperatively, 3 of whom underwent secondary arthroscopic elbow release, with 2 achieving satisfactory functional recovery. All patients demonstrated significant improvement in the Mayo Elbow Performance Score compared to preoperative values. Conclusions The use of autologous iliac bone and radial head grafts to reconstruct massive coronoid defects associated with persistent elbow dislocation has demonstrated reliable bone healing and joint stability, with a low incidence of joint re-dislocation or graft absorption. Combined with arthroscopic release procedures, this operation can restore elbow function to meet the demands of daily activities, obviate the need for joint replacement, and improve patient outcomes.

Key words： Coronoid deficiency; ; ; Coronoid reconstruction; ; ; Autogenous bone graft; ; ; Joint dislocation

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