关节镜下克氏针张力带修复肘内翻-后内侧旋转不稳

doi:10.3877/cma.j.issn.1674-134X.2026.02.004

目的

探索关节镜下克氏针张力带固定冠突骨折联合小切口修复外侧副韧带损伤治疗肘内翻-后内侧旋转不稳（VPMRI）的临床疗效及并发症。

方法

本研究采用回顾性病例对照研究。纳入2019年3月至2022年9月期间徐州仁慈医院20例肘内翻-后内侧旋转损伤患者；排除既往合并肘关节僵硬患者。其中男9例，女11例；左肘4例，右肘16例；所有患者均在关节镜下克氏针张力带固定冠突骨折联合小切口修复外侧副韧带损伤手术治疗。观察指标包括手术时间、术中出血量、肘关节活动度（屈曲、伸直、内旋、外旋）、疼痛视觉模拟评分（VAS）、Mayo肘关节功能评分（MEPS），并采用t检验进行比较分析；记录并发症（异位骨化、关节僵硬、神经损伤、皮肤刺激症状）、患者满意度及骨折愈合情况。

结果

所有患者均获得（16±5）个月随访，平均年龄（30±12）岁。手术时间为（85±11）min，术中出血量（56±10）ml；末次随访时，肘关节活动度：屈曲（137.3±8.6）°、伸直（-1.5±2.8）°、内旋（84.3±5.3）°、外旋（82.3±8.3）°，均优于术前的（61.3±10.1）°、（-16.5±7.5）°、（43.1±9.8）°、（40.3±6.5）°，差异均具有统计学意义（t=25.622、8.379、16.538、17.817，均为P<0.05）；末次随访肘关节Mayo评分（97±4）分，显著优于术前（42±7）分，差异具有统计学意义（t=30.509，P=0.001）；末次随访肘关节VAS评分（1.3±0.6）分，较术前VAS评分（7.1±1.3）分明显改善，差异具有统计学意义（t=18.116，P=0.001）。并发症：尺神经损伤2例（分别于术后3、6个月均恢复正常），异位骨化1例，皮肤刺激症状1例，无关节僵硬。患者对术后关节功能均满意，骨折愈合均良好。

结论

尽管关节镜下克氏针张力带固定冠突骨折联合小切口修复外侧副韧带损伤治疗肘内翻-后内侧旋转损伤技术要求高，但术后可早期功能锻炼，减少术后并发症。

关键词: 关节镜, 骨针, 肘, 手术后并发症, 关节不稳定性

Objective

To evaluate the clinical efficacy and complications of arthroscopic tension band wiring with Kirschner wires for coronoid process fractures combined with mini-incision repair of lateral collateral ligament injuries in the treatment of varus posteromedial rotatory instability (VPMRI) of the elbow.

Methods

This was a retrospective case-control study. Between March 2019 and September 2022, a total of 20 patients with cubitusvarus and posteromedial rotatory instability who were treated at Xuzhou Renci Hospital were enrolled. Patients with pre-existing elbow stiffness were excluded. The cohort comprised nine males and 11 females, with four left and 16 right elbow injuries. All the patients underwent arthroscopic Kirschner wire tension band fixation for the coronoid fracture combined with a small-incision repair of the lateral collateral ligament injury.Observation indicators included operation time, intraoperative blood loss, elbow range of motion (flexion, extension, internal rotation, external rotation), the visual analogue scale (VAS) for pain, and the Mayo elbow performance score (MEPS). Complications (heterotopic ossification, joint stiffness, nerve injury, skin irritation), patient satisfaction, and fracture healing were recorded. Paired t tests were used for statistical comparisons.

Results

All the patients were followed up for (16±5) months. The mean age was (30±12) years. The mean operation time was (85±11) min, and the mean intraoperative blood loss was (56±10) ml. At the final follow-up, the elbow range of motion [flexion (137.3±8.6)°, extension (-1.5±2.8)°, internal rotation (84.3±5.3)°, external rotation (82.3±8.3)°] showed significant improvement compared to preoperative values [(61.3±10.1)°, (-16.5±7.5)°, (43.1±9.8)°, (40.3±6.5)°] (t=25.622, 8.379, 16.538, 17.817, all P<0.05). The final MEPS was 97±4 significantly higher than the preoperative score of 42±7 (t=30.509, P=0.001). The final VAS score was 1.3±0.6, significantly lower than the preoperative score of 7.1±1.3 (t=18.116, P=0.001).

Conclusion

Although arthroscopic tension band fixation of coronoid fractures combined with mini-open lateral collateral ligament repair for VPMRI is technically demanding, it allows early postoperative rehabilitation and reduces complications.

Key words: Arthroscope, Bone wires, Elbow, Postoperative complications, Joint instability

表1 肘VPMRI外侧副韧带损伤修复术前后关节功能指标比较（

x ¯

±s）

Table 1 Comparison on joint function indices before and after elbow lateral collateral ligament injury repair

时间 Time	Mayo评分 Mayo score	ROM（°）				VAS
时间 Time	Mayo评分 Mayo score	屈曲 Flexion	伸直 Extension	内旋 Internal rotation	外旋 External rotation	VAS
术前 Before operation	42.0±7.0	61.3±10.1	-16.5±7.5	43.1±9.8	40.3±6.5	7.1±1.3
术后末次随访 Last follow-up after operation	97.0±4.0	137.3±8.6	-1.5±2.8	84.3±5.3	82.3±8.3	1.3±0.6
t值	30.509	25.622	8.379	16.538	17.817	18.116
P值	0.001	<0.05	<0.05	<0.05	<0.05	0.001

表1 肘VPMRI外侧副韧带损伤修复术前后关节功能指标比较（

x ¯

±s）

Table 1 Comparison on joint function indices before and after elbow lateral collateral ligament injury repair

时间 Time	Mayo评分 Mayo score	ROM（°）				VAS
时间 Time	Mayo评分 Mayo score	屈曲 Flexion	伸直 Extension	内旋 Internal rotation	外旋 External rotation	VAS
术前 Before operation	42.0±7.0	61.3±10.1	-16.5±7.5	43.1±9.8	40.3±6.5	7.1±1.3
术后末次随访 Last follow-up after operation	97.0±4.0	137.3±8.6	-1.5±2.8	84.3±5.3	82.3±8.3	1.3±0.6
t值	30.509	25.622	8.379	16.538	17.817	18.116
P值	0.001	<0.05	<0.05	<0.05	<0.05	0.001

图1 左肘尺骨冠突骨折合并外侧副韧带损伤。图A~B为术前肘关节三维CT扫描，示冠突骨折；图C为关节镜下PDS（聚二氧环己酮线）通过腰穿针进入关节腔；图D为抓钳抓住PDS；图E为抓钳将PDS缠绕于克氏针尖部；图F为术中小切口，聚醚醚酮锚钉修复外侧副韧带损伤；图G~H为术中微型C臂机透视，观察克氏针位置；图I为术后伤口照片；图J为术后12个月肘关节屈伸、外旋、内旋良好

Figure 1 Left elbow coronoid process fracture with lateral collateral ligament injury. A and B are preoperative three dimensional-CT images of the elbow, showing coronoid process fracture; C is arthroscopic view, showing PDS (polydioxanone suture) introduced into the joint cavity via a spinal needle; D shows grasper retrieving the PDS; E shows the grasper wrapping the PDS around the tip of a Kirschner wire; F is intraoperative view of a mini-incision, demonstrating lateral collateral ligament repair using a polyetherether ketone suture anchor; G and H are intraoperative fluoroscopy images from a mini C-arm, confirming Kirschner wire positioning; I is postoperative wound appearance; J shows excellent range of motion in elbow flexion, extension, external rotation, and internal rotation at the 12 months follow-up

图2 右肘关节冠突骨折合并外侧副韧带损伤。图A~B为术前行肘关节三维CT扫描，显示冠突骨折；图C为关节镜下见冠突骨折；图D为抓线钳抓住PDS（聚二氧环己酮线）；图E为PDS线绕过克氏针固定骨折块；图F为肘关节外侧小切口修复外侧副韧带损伤；图G~H为术中透视，观察克氏针及骨折块位置良好；图I为伤口缝合术后外观；图J为术后12个月随访，肘关节活动度屈曲、伸直、外旋及内旋良好

Figure 2 Right elbow coronoid process fracture with lateral collateral ligament injury. A and B are preoperative three dimensional-CT images of the elbow, demonstrating the coronoid process fracture；C is arthroscopic view confirming the coronoid process fracture；D shows the PDS (polydioxanone suture) grasped by a suture retriever；E shows the PDS suture looped around a Kirschner wire to secure the fracture fragment；F is lateral mini-open approach of the elbow for the repair of the lateral collateral ligament injury；G and H are intraoperative fluoroscopic images, confirming satisfactory positioning of the Kirschner wires and the fracture fragment；I is the view of the closed surgical wound；J is range of motion at 12 months follow-up after surgery, showing excellent elbow recovery of flexion, extension, external rotation, and internal rotation

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Arthroscopic Kirschner wire tension band fixation for elbow varus posteromedial rotator instability

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Arthroscopic Kirschner wire tension band fixation for elbow varus posteromedial rotator instability