肘关节恐怖三联征的治疗体会

Surgical treatment of terrible triad of the elbow

目的：回顾性分析手术治疗肘关节恐怖三联征的临床疗效。方法2008年1月～2013年7月收治肘关节恐怖三联征15例患者，其中男性10例，女性5例；年龄19～45岁，平均31岁。采用手术切开复位，空心拉力螺钉或克氏针固定骨块并同时修复侧副韧带，术后早期功能锻炼。采用Mayo肘关节功能评分标准进行疗效评价。结果术后15例获得4个月～2年随访，平均20个月。骨折复位及愈合良好，无畸形愈合，平均愈合时间为12周（8～20周）。肘关节屈伸活动度平均为105．5°，前臂旋转活动度平均为122°，无肘关节僵硬及医源性桡神经损伤并发症。随访结果采用Mayo肘关节功能评分：优4例，良8例，一般3例。结论肘关节恐怖三联征应积极采取手术治疗，尽可能重建骨关节和软组织结构。术后行早期功能锻炼，最大限度避免关节僵硬和恢复关节功能。

Objective To retrospectively analyze the clinical efficiency of surgical treatment of terrible tri-ad of the elbow.Methods Fifteen patients from Jan.2008 to Jul.2013 with terrible triad of the elbow were in-volved into the research and treated with open reduction and internal fixation surgery to repair ligaments at the same time,of whom ten cases were male,5 were female aged from 19-45 years old（ average 31 years old） .Early post-operative functional exercises were implemented.The Mayo Elbow Performance Index（ MEPI） was employed to e-valuate the efficiency.Results Fifteen cases were followed up for 4-24 months with 20 months on average.All fractures achieved good reduction and the bones healed well.The bone healing time was 12 weeks on average（8-20 weeks）.The average range of motion of the elbow was 105.5°,and the mean pronation-supination angle of the forearm was 122°respectively.No complication such as stiffness and iatrogenic injury of radial nerve occurred.Ac-cording to MEPI,the results were excellent in 4 cases,good in 8 cases and fair in 3 cases.Conclusion The terri-ble triad of the elbow should be actively treated with operation to reconstruct the joints and soft tissue.Early postop-erative functional exercise could be implemented in order to avoid immobilization and recover the articular function.