肘关节“恐怖三联征”尺侧副韧带的修复重建临床体会

Reconstruction of Medial Collateral Ligament to "Terrible Triad" of Elbow-joint

目的:探讨肘关节尺侧副韧带(MCL)修复重建在肘关节"恐怖三联征"的临床治疗体会。方法:回顾性分析2008年1月-2010年11月我科收治的5例肘关节"恐怖三联征"患者的临床资料,桡骨头骨折按改良Mason分型,Ⅱ型3例,Ⅲ型2例;尺骨冠突骨折按Regan-Morrey分型,Ⅰ型2例,Ⅱ型3例。术中骨折复位固定后,检查肘关节外翻不稳,采用肘内侧入路进行探查,并行MCL修复或重建;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7～12d,早期开始进行肘关节屈伸和前臂旋转的主动功能锻炼。结果:术后随访1～2年,5例患者伤口均Ⅰ期愈合;骨折愈合良好,临床愈合时间平均12周(8～19周)。采用Mayo肘关节功能评分,优3例,良2例。在肘关节90°位测量前臂的旋转范围,本组前臂旋前平均75°(35°～85°),前臂旋后平均80°(65°～89°)。结论:MCL是肘关节内侧稳定的主要结构,临床上肘关节"恐怖三联征"有MCL损伤时,如果骨折复位固定后仍然存在外翻不稳定者,应修复或重建MCL。

Objective：To evaluate the clinical effect of the reconstruction of the medial collateral ligament（MCL）on patients with＂terrible triad＂of elbow-joint.Methods：5 cases with elbow＂terrible triad＂with release of the MCL were operated by excision of the radial head,reconstruction of the MCL form January 2008 to November 2010.The radial head fracture type according to the modified Mason,Ⅱ type 3 cases,Ⅲ type 2 cases,ulna coronoid fractures according to Regan-Morrey classification,Ⅰtype 2 cases,Ⅱ type 3 cases.To evaluate the effect of the treatment with range of joint movement,the elbow function,the early functional exercise of elbow and forearm rotation.Results：Patients were followed up 1 to 2 years,5 patients were stageⅠwound healing and fracture healed well,clinical healing time average of 12 weeks（8 to 19 weeks）.Mayo elbow score with excellent in 3 cases,good in 2 cases.Level measurement in the elbow 90°of forearm rotation range,the group mean pronation 75°（35°～85°）,forearm supination average of 80°（65°～89°）.Conclusion：MCL is the main structure stability of elbow ＂terrible triad＂ when MCL injury.After fractures fixed,there are still when valgus instability.