肱骨小頭,、肱骨外側(cè)髁和滑車骨折可造成肘關(guān)節(jié)不穩(wěn)定,，這種骨折線甚至可延伸到內(nèi)側(cè)髁，需要手術(shù)處理,。目前的后方手術(shù)入路對(duì)于顯露肱骨遠(yuǎn)端前方關(guān)節(jié)面作用有限,。作者提出通告外側(cè)髁截骨，外旋肱骨可引起肘關(guān)節(jié)脫位,，從而更好的顯露肱骨遠(yuǎn)端前方關(guān)節(jié)面,，并優(yōu)于尺骨鷹嘴截骨。

A 關(guān)節(jié)囊切開  B  截骨后造成肘關(guān)節(jié)脫位

病例：肱骨小頭骨折,，肱骨外側(cè)髁LCL起點(diǎn)撕脫骨折,，LCL (+)向遠(yuǎn)端掀開后可見肱骨遠(yuǎn)端關(guān)節(jié)面（#）和橈骨頭（*）。直視下復(fù)位并采用接骨板和帶螺紋克氏針固定,。

     采用亞甲基藍(lán)染色比較肘關(guān)節(jié)脫位入路和尺骨鷹嘴截骨對(duì)于肱骨遠(yuǎn)端關(guān)節(jié)面的顯露程度,。肘關(guān)節(jié)脫位入路對(duì)于顯露肱骨遠(yuǎn)端前方關(guān)節(jié)面更有優(yōu)勢(shì)。但此項(xiàng)研究?jī)H進(jìn)行了尸體研究，對(duì)于手術(shù)的并發(fā)癥還需進(jìn)一步評(píng)估,。

      作者在前面的基礎(chǔ)上進(jìn)行手術(shù)改良,，不僅顯露肱骨遠(yuǎn)端關(guān)節(jié)面，而且可顯露冠突前方關(guān)節(jié)面,。

Fig. 1 a The lateral collateral ligament and extensor insertion were turned distally to expose the distal articular surface of the humerus. b After identifying the lateral collateral ligament complex of the elbow joint, a pendulum saw was utilized to perform an osteotomy on the lateral epicondyle of the humerus. c The distal humeral surface was exposed after the release of the lateral collateral ligament complex. d The elbow joint demonstrates partial flexion and inversion, with the medial axis resembling a rotational hinge axis. The anterior and lateral dislocation of the distal humerus without tension resulted in complete exposure of the distal articular surface,。

肘關(guān)節(jié)脫位后顯露的關(guān)節(jié)面

尺骨鷹嘴截骨顯露的關(guān)節(jié)面

兩者對(duì)于關(guān)節(jié)面顯露的比較