肘关节恐怖三联征,就是这么恐怖!

2017-02-26 佚名 医学界

肘关节后脱位同时伴有尺骨冠状突骨折和桡骨头骨折,称为“肘部严重损伤三联征( terrible triad of the elbow) ”。这是肘部严重的高能量创伤, 由施加于上肢纵轴方向的压缩和剪切暴力引起, 坠落和车祸是常见原因。除了三联损伤外,还常伴有肘内、外侧副韧带和前臂骨间膜的撕裂, 桡骨和(或) 尺骨的骨折, 下尺桡关节分离等。因此整个肘部和前臂显得十分不稳定。肘关节是一个包含肱尺关节(

肘关节后脱位同时伴有尺骨冠状突骨折和桡骨头骨折,称为“肘部严重损伤三联征( terrible triad of the elbow) ”。这是肘部严重的高能量创伤, 由施加于上肢纵轴方向的压缩和剪切暴力引起, 坠落和车祸是常见原因。除了三联损伤外,还常伴有肘内、外侧副韧带和前臂骨间膜的撕裂, 桡骨和(或) 尺骨的骨折, 下尺桡关节分离等。因此整个肘部和前臂显得十分不稳定。



肘关节是一个包含肱尺关节(肱骨滑车—尺骨滑车凹) 、肱桡关节(肱骨头—桡骨头凹) 和上尺桡关节的复合关节,以肱尺关节对肘关节的稳定性最重要。同时, 肘关节囊、侧副韧带和肌肉对维持关节的稳定亦有重要作用。肘关节后脱位主要发生在肱骨滑车与尺骨滑车凹之间。

损伤机制

肘关节在近伸直位,遭受轴向高能量的压缩剪切暴力,导致肘部损伤恐怖三联征。

轴向高能量的压缩剪切暴力,先使桡骨头撞击肱骨小头发生桡骨头的骨折,继续造成冠状突的骨折,再引起肘关节的后脱位和肌腱、韧带的损伤。

冠状突骨折块的大小与肘关节的伸直程度有明确的关系。

冠状突骨折

Regan和Morrey分型:

Ⅰ型:冠突尖部骨折 (骨折块高度<10%冠突高度 )

Ⅱ型:冠突体部骨折(骨折块高度10%-50%冠突高度)

Ⅲ型:冠突基底骨折(骨折块高度>50%冠突高度)

桡骨头骨折

Mason分型:

I型: 桡骨头边缘小片骨折(<25% )。

II型: 桡骨头部分骨折,能够重

III型: 桡骨头完全骨折,不能重建。

IV型: 桡骨头完全骨折,伴肘关节脱位。


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  1. [GetPortalCommentsPageByObjectIdResponse(id=1634381, encodeId=03c816343811f, content=<a href='/topic/show?id=57ce8110820' target=_blank style='color:#2F92EE;'>#肘关节#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81108, encryptionId=57ce8110820, topicName=肘关节)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fd5022160969, createdName=xugc, createdTime=Sat Dec 30 11:30:00 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189112, encodeId=e61518911211, content=学习了,肘关节恐怖三联征。, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Thu Apr 20 18:27:33 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=178209, encodeId=6ad01e8209da, content=不错!临床工作中记住了就好, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQplCaQGBmjHytXQqvsuocO2uV2lOAaJibzDafJudKToVfU12LzwArHDb4TSrmU2hk5Qxzc6icoicBK3Dg/0, createdBy=a7901968505, createdName=明心见性, createdTime=Tue Feb 28 15:53:16 CST 2017, time=2017-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=178156, encodeId=983f1e815645, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Feb 28 07:17:24 CST 2017, time=2017-02-28, status=1, ipAttribution=)]
    2017-12-30 xugc
  2. [GetPortalCommentsPageByObjectIdResponse(id=1634381, encodeId=03c816343811f, content=<a href='/topic/show?id=57ce8110820' target=_blank style='color:#2F92EE;'>#肘关节#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81108, encryptionId=57ce8110820, topicName=肘关节)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fd5022160969, createdName=xugc, createdTime=Sat Dec 30 11:30:00 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189112, encodeId=e61518911211, content=学习了,肘关节恐怖三联征。, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Thu Apr 20 18:27:33 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=178209, encodeId=6ad01e8209da, content=不错!临床工作中记住了就好, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQplCaQGBmjHytXQqvsuocO2uV2lOAaJibzDafJudKToVfU12LzwArHDb4TSrmU2hk5Qxzc6icoicBK3Dg/0, createdBy=a7901968505, createdName=明心见性, createdTime=Tue Feb 28 15:53:16 CST 2017, time=2017-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=178156, encodeId=983f1e815645, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Feb 28 07:17:24 CST 2017, time=2017-02-28, status=1, ipAttribution=)]
    2017-04-20 邓启付

    学习了,肘关节恐怖三联征。

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1634381, encodeId=03c816343811f, content=<a href='/topic/show?id=57ce8110820' target=_blank style='color:#2F92EE;'>#肘关节#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81108, encryptionId=57ce8110820, topicName=肘关节)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fd5022160969, createdName=xugc, createdTime=Sat Dec 30 11:30:00 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189112, encodeId=e61518911211, content=学习了,肘关节恐怖三联征。, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Thu Apr 20 18:27:33 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=178209, encodeId=6ad01e8209da, content=不错!临床工作中记住了就好, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQplCaQGBmjHytXQqvsuocO2uV2lOAaJibzDafJudKToVfU12LzwArHDb4TSrmU2hk5Qxzc6icoicBK3Dg/0, createdBy=a7901968505, createdName=明心见性, createdTime=Tue Feb 28 15:53:16 CST 2017, time=2017-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=178156, encodeId=983f1e815645, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Feb 28 07:17:24 CST 2017, time=2017-02-28, status=1, ipAttribution=)]
    2017-02-28 明心见性

    不错!临床工作中记住了就好

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1634381, encodeId=03c816343811f, content=<a href='/topic/show?id=57ce8110820' target=_blank style='color:#2F92EE;'>#肘关节#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81108, encryptionId=57ce8110820, topicName=肘关节)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fd5022160969, createdName=xugc, createdTime=Sat Dec 30 11:30:00 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189112, encodeId=e61518911211, content=学习了,肘关节恐怖三联征。, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Thu Apr 20 18:27:33 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=178209, encodeId=6ad01e8209da, content=不错!临床工作中记住了就好, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQplCaQGBmjHytXQqvsuocO2uV2lOAaJibzDafJudKToVfU12LzwArHDb4TSrmU2hk5Qxzc6icoicBK3Dg/0, createdBy=a7901968505, createdName=明心见性, createdTime=Tue Feb 28 15:53:16 CST 2017, time=2017-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=178156, encodeId=983f1e815645, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Feb 28 07:17:24 CST 2017, time=2017-02-28, status=1, ipAttribution=)]
    2017-02-28 ylzr123

    认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。

    0

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