人工桡骨头置换在肘关节恐怖三联征中的应用

The effect of radial head replacement on terrible triad of elbow

目的 观察人工桡骨头置换治疗肘关节恐怖三联征的近期疗效.方法 2011年6月至2012年6月采用人工桡骨头置换治疗肘关节恐怖三联征6例,男4例,女2例;年龄23～50岁,平均39岁.新鲜肘关节骨折脱位5例,陈旧性骨折1例.桡骨头骨折MasonⅡ型2例,MasonⅢ型4例.对肘关节恐怖三联征进行切开复位,尺骨冠突骨折固定（螺钉固定1例、不可吸收缝线固定4例）、人工桡骨头置换、外侧韧带复合体修复及环状韧带修复或重建（修复环状韧带1例、掌长肌腱重建环状韧带2例）.术后第5至7天逐步开始肘关节功能锻炼.术后复查肘关节正侧位X线片,术后3个月复查肘关节三维CT,并采用Myao肘关节功能评分（Myao elbow performance score,MEPS）评价肘关节功能.结果 6例均获得随访,随访时间10～24个月,平均16.8个月.术后3个月肘关节MEPS评分85～95分,平均91.7分;优5例,良1例.肘关节活动度（采用标准中立位0度法测量）：屈82°～95°,平均87°;伸15°～32°,平均21°;旋前82°～90°,平均86°;旋后45°～80°,平均56°.随访期间未出现肘关节不稳、脱位或半脱位、创伤性关节炎及感染.1例因桡骨头假体位置欠佳使肱骨与桡骨头假体间隙变窄而影响肘关节屈曲活动度.2例出现未影响肘关节功能的Hahi 1级异位骨化.结论 采用人工桡骨头置换治疗伴有桡骨头粉碎性骨折的肘关节恐怖三联征能恢复肘关节稳定性,减少肘关节僵硬、脱位及半脱位等并发症的发生.

Objective To observe the short-term effect of radial head replacement for the treatment of terrible triad of the elbow.Methods In the period between June 2011 and June 2012,the radial head replacements were carried out in six patients with terrible triad of elbow.There were five acute elbow fracture-dislocation cases and one old fractnre case.All cases underwent open reduction and fixation coronoid fracture with screws or nonabsorbable sutures,radial head replacement,repair of lateral ligament complex and repair or reconstruction of annular ligament.All patients initiated the rehabilitation program under supervision within 5-7 days after surgery.The X-ray and Computed tomography of elbow was used to evaluate the posi tion of radial head prosthesis.Functional outcome of elbow was assessed by Mayo Elbow Performance Score （MEPS） and complications.Results All patients were participated in follow-up for 10-24 months and the mean duration of follow-up was 16.8 months.The MEPS was from 85 to 95 points and the mean MEPS was 91.7 points.The outcome of MEPS was excellent in 5 cases,good in 1 case.The range motion of elbow flexion was from 82 to 95 degrees and the average of elbow flexion was 87 degrees; the range motion of extension was from 15 to 32 degrees and the average of elbow extension was 21 degrees.The range motion of fore-ann pronation was from 82 to 90 degrees with 86 degrees in average.The motion range of supination was from 45 to 80 degrees with 56 degrees in average.All cases got persistent stability in elbow with painless movement.None of patient suffered traumatic arthritis and infection.The motion range of elbow was restricted due to the unfit relative position of radial head prosthesis and capi tellum in one case,characterized by decreasing radiocapitellar joint space.Two cases developed into heterotopic ossification in elbow without hampering the motion range of elbow.Conclusion The outcome of the radial head replacement on the treatment of radial head fracture in the elbow ＂terrible triad＂ was satisfactory.However,the longer duration of observation was essential to verify the favorable effect of radial head replacement on dealing with terrible triad in elbow.