改良手术方法治疗肘关节恐怖三联征的短期疗效分析

Modified surgical technique for terrible triad of elbow and short-term efficacy

目的观察改良手术方法治疗肘关节“恐怖三联征”的短期疗效。方法回顾性分析自2013—10—2015-09采用改良手术方法治疗的10例肘关节“恐怖三联征”。术中对桡骨头、外侧副韧带复合体以及内侧副韧带复合体重建，而未修复尺骨冠状突。结果本组手术时间65～160（100．10±32．32）min，术中失血量150～500（287．20±132．17）ml。10例均获得随访6—15（10．90±2．77）个月，无切口感染、尺神经麻痹表现、肘关节再脱位、骨化性肌炎等并发症。X线片显示骨折均在术后3个月内愈合。末次随访肘关节屈曲活动度110°～130°（118．53±6．11）°，伸展活动度为0°-20°（13．40±6．33）°，前臂旋前活动度45°～80°（63．20±11．46）°，旋后活动度25°-75°（52．91±15．31）°。Mayo肘关节功能评分80～94（87．12±4．01）分，优8例,良2例。结论在不固定Regan—MorreyⅠ、Ⅱ型冠状突骨折的情况下，通过手术固定或修补肘关节其他结构，也能恢复“恐怖三联征”患者的肘关节稳定性，且短期疗效良好。

Objective To introduce a modified surgical technique for terrible triad of the elbow and observe its short-term efficacy. Methods Ten patients with terrible triad of the elbow were retrospectively analyzed from Oct. 2013 to Sept. 2015. The radical head, lateral collateral ligament complex （LCLC） and medical collateral ligament complex （MCLC） were reconstructed, but the coronoid process was not repaired. Results In this group, operation time was 65-160 （100.10±32.32） min, blood loss was 150-500 （287.20±132.17）ml. All 10 patients were evaluated. The follow-up time was 6-15 （10.90±2.77） months. No complications, such as incision infection, ulnar nerve plasysis, elbow redisloeation and myositis ossificans, were observed. All fracture union was observed in 3 months＂ X-ray postoperatively. The flexion, extension, pronation and supination arc of movement were 110° -130° （118.53 ±6.11）°, 0° -20° （13.40 ±6.33）°, 45° -80° （63.20 ± 1.4）°, 25° -75° （52.91 ±15.31）° respectively. The mean Mayo elbow performance score （MEPS） were 80-94 （87.12±4.01） points with 4 excellent and 6 good results. Conclusion The elbow stability could be reconstructed by means of repairing radical head, LCLC and MCLC without Regan-Morrey type Ⅰ or Ⅱ coronoid process fracture fixation. The short-term efficacy is good.