手术治疗肘关节“恐怖三联征”的短期疗效分析

The surgical treatment effect analysis of the terrible triad of elbow:a short-term follow-up

目的 探讨手术治疗肘关节＂恐怖三联征＂的手术方法 和临床疗效.方法 2005年6月～2009年2月,本组应用手术治疗闭合性肘关节＂恐怖三联征＂患者6例.桡骨头骨折按改良Mason分型,Ⅰ型2例,Ⅱ型4例;尺骨冠突骨折按Regan-Morrey分型,Ⅰ型3例,Ⅱ型3例.术中发现肘内、外侧副韧带均有撕裂.按照McKee手术方法 ,所有患者采用肘内、外侧联合入路进行手术治疗;术后在肘关节屈曲90°和前臂旋转中立位的姿势下,以长臂石膏后托外固定7～10 d,之后开始进行肘关节屈伸和前臂旋转的主动训练.结果 术后随访6例,随访时间12～26个月,平均随访时间15个月.6例患者伤口均Ⅰ期愈合;骨折亦复位良好,未见畸形愈合,临床愈合时间平均为11周（8～19周）;2例患者术后6个月X线片显示肘关节轻度异位骨化;2例患者术后15个月X线片显示肘关节轻度退行性改变;最后随访时肘关节屈伸活动度（109±12）°,前臂旋转活动度（97±15）°,未发现肘关节僵硬、复发性脱位以及桡神经损伤症状;采用Mayo肘关节功能评估指数对随访患者进行评价,其中优2例,良3例,一般1例.结论 肘关节＂恐怖三联征＂由于伴发损伤多,导致肘关节的严重不稳;只有通过手术治疗,恢复和重建肘关节的稳定结构,同时配合早期的康复训练,才能较好地恢复肘关节的功能.

Objective To explore the operation and clinical results of ＂terrible triad of elbow＂. Methods Six cases of closed ＂terrible triad of elbow＂ were treated by operation in our department from June 2005 to Feb 2009. There were two cases of type Ⅰand four cases of type Ⅱ according to upgraded Mason classification; while according to Rcgan-Morrey classification, there were three cases in type Ⅰand type Ⅱ respectirely; both medial and lateral ligaments were teared in each case. All cases were operated by lateral approach combined with medial approach according to McKee＇s operation process. After operation, the affected limb was immobilizated with plaster, keeping the elbow flex in 90 degrees and the forearm rotated in neutral, then physical exercise was carried out. Results Six cases were followed up for twelve to twenty-six months, fifteen months on average. All of the the operative incisions of six cases were healed by first intention; all the fracture pieces were reestablished and the bones healed without malunion. The bone healing time was eleven weeks on average （eight to nineteen weeks）. Six months after operation, two cases＇ X- Rays showed that slight heterotopic ossification （ HO ） occurred around the elbows; fifteen months after operation, two cases＇ X- Rays showed that the elbows began to degenerate. Six flexionextension range of the elbows was （ 109 ±12 ）°and the pronation-supination range of the forearms was （97±15 ）°respectively. No complications such as stiffness of the elbow, recurred dislocation and injury of radial nerve occurred. All the cases were evaluated according to Mayo Elbow Performance Score （MEPS） , and the results were excellent in two cases, good in three cases and fair in one case. Conclusions Terrible triadof elbow leads to serious instability due to many associated injuries, so, only to restore the anatomic structures by operation and early exercise, the postoperatively function of elbow would be satisfactory.