切开复位内固定结合外固定支架治疗肘关节“恐怖三联征”

Operative Treatment of Terrible Triad of the Elbow by Hinged External Fixator

目的:探讨应用铰链式外固定支架结合有限内固定、周围软组织修复和重建治疗肘关节"恐怖三联征"的疗效。方法:回顾性分析2005年3月-2009年9月,采用外固定支架结合有限内固定治疗肘关节"恐怖三联征"患者12例。采用肘内外侧联合入路行骨折复位内固定,并辅以铰链外固定支架固定。外固定支架平均使用7.5周(6～8周),术后第1天开始前臂旋转功能锻炼,4～6d行肘关节屈伸活动。以Mayo肘关节评分标准进行功能评定。结果:所有病例均完整随访,随访时间12～36个月,平均20.4个月。骨折临床愈合平均时间9周。术后随访肘关节屈伸度平均116.7°,前臂旋转度平均131.4°,Mayo评分平均86分(67～94分),优6例,良4例,中2例。无关节僵硬、异位骨化、肱尺关节炎等并发症发生。结论:"恐怖三联征"造成肘关节严重不稳定,应采取手术治疗,尽可能恢复骨性解剖结构、修复关节囊及侧副韧带,并辅以铰链式外固定支架,增加肘关节侧方稳定性,有利于维持骨折脱位的复位,保证早期安全的功能锻炼,预防关节僵硬,减少异位骨化的发生,对早期肘关节的功能恢复更具优越性。

Objective：To detect the curative effect of terrible triad of the elbow by hinged external fixator combined with in- ternal fixation and soft tissue repair. Methods： Retrospectively analyzed 12 cases of terrible triad of the elbow which were treated by unilateral hinged external fixator combined with finite internal fixation from Mar. 2005 to Sep. 2009, including 9 males and 3 females, ranging from 20 to 54 years, with an average age of 31.3 years. All cases underwent reduction and internal fixation by lateral and medial approach, combined with external fixation. The mean time of external fixation was 7. 5 weeks （6--weeks）, and forearm rotation function exercise was performed in the first day of the operation, and the el- bow flexion and extension activities was performed 4 -6 days after operation. Mayo assessment score were used to evalu- ate the elbow joint function. Results.. All the patients were followed up for 12 to 36 months, with an average of 20.4 months. The mean time of fracture healing was 9 weeks. The mean flexion--extension activity of the elbow was 116.7°, and the mean rotation activity of the forearm was 231.4°. The average Mayo elbow score was 86 （67-94 score）. There were 6 patients rated as excellent, 4 good, and 2 fair. There were no complications such as stiffness, heterotopic ossifica- tion and ulnohumeral arthrosis. Conclusion：The terrible triad of the elbow can lead to serious elbow instability and should be treated with operation to restore the anatomic structures, to repair the articular capsule and the collateral ligament, u- sing the adjuvant hinged external fixator which can enhance lateral stability of elbows, benefit the reduction of fracture dis- location, guarantee early safe functional exercise, prevent elbow stiffness, and reduce heterotopic ossification. In treating terrible triad of the elbow, the hinged external fixator is superior to other therapies in the respect of improving the function of elbow joint.