肘关节后脱位伴桡骨头和尺骨冠突骨折(恐怖三联征)5例初步报告

Posterior dislocation of the elbow with radial head and ulnar coronoid fractures(terrible triad):a report of 5 cases

[目的]介绍"肘关节恐怖三联征"的概念(肘关节后脱位同时伴有桡骨头和尺骨冠突骨折),并报告5例患者的临床治疗体会。[方法]自2004年4月～2007年3月,作者共收治肘关节三联征损伤5例。桡骨头骨折按Mason法分类:Ⅱ型4例,Ⅲ型1例;按Schatzker法分类:Ⅰ型1例,Ⅱ型3例,Ⅲ型1例。尺骨冠突骨折按Regan-Morrey法分类:Ⅰ型1例,Ⅱ型4例;按O′Driscoll法分类:5例均为Ⅰ型。4例采取了手术内固定治疗,以3 mm钛空心拉力螺钉或1 mm K针分别固定冠突和桡骨头,并缝合修复肘内外侧副韧带。术后屈肘90°前臂旋转中立位石膏外固定3周,开始屈伸和旋转康复训练。[结果]4例手术治疗的患者经3个月～3年随访,骨折愈合,肘关节稳定,无疼痛。肘关节屈伸幅度平均120°,前臂旋转幅度平均110°。3例随访1年以上,Mayo肘关节功能评分:优2例,良1例。未手术治疗的1例功能评定为差,有肘关节不稳定和疼痛。[结论]肘关节恐怖三联征的骨折片虽然很小,但伴有肘内外侧副韧带撕裂,肘关节严重不稳定。只有在重建了骨关节和软组织结构稳定的基础上,及早(3周内)进行康复锻炼,才能获得较好的功能恢复。

[ Objective] To introduce the new concept of ＂terrible triad of the elbow＂ , and report the preliminary results of 5 clinical cases. [ Method ] From April 2004 to March 2007, five cases met the diagnosis of terrible triad, with posterior dislocation of elbow complicated with radial head and ulnar coronoid fractures. The radial head fractures were 4 in type Ⅱ and Ⅰ in type Ⅲ according to Mason classification,and Ⅰ in type Ⅰ , Ⅲ in type Ⅱ and 1 in type Ⅲ according to Schatzker classification. The ul- nar coronoid fractures were Ⅰ in type Ⅰ , IV in type Ⅱ according to Regan-Morrey classification, and all 5 in type Ⅰ according to ODriscoll classification. Four patients underwent surgical operations. The fractured radial head and ulnar coronoid were re- duced and fixed with 3mm titanic lag screws or K wires, the lateral and medial collateral ligaments were repaired with Krachow sutures. A plaster of Paris was applied for 3 weeks after operation, in position with elbow flexion in 90 degrees and forearm rotation in neutral. Then physical exercise and rehabilitation program were carried out. [ Result] Four operated patients were followed up for 3 months to 3 years, with healed fractures, stable elbow and no pain movement. The average range of elbow flexion-extension were 120 degrees, and forearm pronation-supination were 110 degrees, respectively. The functional outcome in 3 cases that followed up more than Ⅰ year was excellent in 2 and good in Ⅰ according to Mayo Elbow Performance Score（MEPS）. The result of the un-operated case was poor in MEPS evaluation. Elbow instability and pain was the main complaint. [ Conclusion ] Terrible triad of posterior dislocation with radial head and ulnar coronoid fractures is a severe trauma to the elbow. Operative osteosythesis and ligament repair is mandatory for concentric reduction and elbow stability.