金属铰链外固定支架与有限针钉置入内固定治疗肘关节“恐怖三联征”

Metal hinged elbow external fixator combined with pins and screw fixation for treatment of terrible triad of the elbow

背景:以往治疗肘关节后脱位伴桡骨头及尺骨冠状突骨折(肘关节恐怖三联征)的手术方法需要长期制动而常常导致肘关节复发性不稳定、肘关节僵硬等并发症的发生。目的:观察铰链支架配合有限内固定治疗肘关节"恐怖三联征"的效果。方法:选择2006-04/2010-06佛山市中医院收治的肘关节"恐怖三联征"患者14例,均采取肘关节内、外侧联合入路针钉置入内固定加金属铰链外固定架治疗。所有患者随访时间≥5个月,记录病情主诉、肘关节屈伸活动度、前臂旋转活动度、关节稳定性、X射线片情况,采用MEPS评分评估肘关节功能。结果与结论:所有患者在末次随访时患侧肘关节均没有明显疼痛及不稳定,无浅表及深部组织感染发生;骨折平均愈合时间(11.30±3.25)周;肘关节平均屈伸范围为(125.42±19.66)°(75°～145°),前臂平均旋转范围为(135.43±17.07)°(80°～150°);2例颅脑损伤患者肘前软组织中出现少量骨化,未影响关节活动。MEPS评分优7例,良5例,可2例,优良率为86%。说明采用内、外侧入路通过铰链支架配合有限内固定能提高肘关节术后初始稳定性,有利于肘关节同心圆性中心复位及软组织修复,便于早期功能锻炼,免去二次手术问题。

BACKGROUND:The previous treatment of elbow dislocations associated with radial head and coronoid fractures(terrible triad of the elbow) are often poor because of recurrent instability,stiffness and other complications from prolonged immobilization.OBJECTIVE:To observe the clinical efficacy on treatment of the terrible triad of the elbow with hinged elbow external fixator with limited internal fixation.METHODS:A total of 14 cases received the terrible triad of the elbow treatment from April 2006 to June 2010 at Foshan Hospital of Traditional Chinese Medicine,were collected.The patients were treated with metal hinged elbow external fixator combined with pin and screw fixation.All patients were followed up for e' 5 months,complained of illness,elbow range of motion,the forearm rotating activity,joint stability and radiographs were recorded.Mayo Elbow Performance Score(MEPS) was used to evaluate the function of elbow.RESULTS AND CONCLUSION:No patient complained pain,instability and no superficial and deep tissue infections occurred at the last follow-up.The mean fracture healing time was(11.303.25) weeks.The average range of elbow flexion-extension were(125.4219.66)(75-145),and forearm pronation-supination were(135.4317.07)(80-150).Two cases of brain injury occurred a small amount of ossification in anterior cubital soft tissue,did not affect the joint motion.The functional outcome was excellent in 7,good in 5 and fair in 2 according to MEPS,the fine and good rate was 86%.Hinged elbow external fixator combined with pins and screw fixation can improve the initial stability,conducive to the elbow of the center of concentric reduction and soft tissue repair and facilitate early functional exercise,eliminate the problem of secondary surgery.