冠状突内固定后修复外侧副韧带与铰链式外固定架治疗肘关节内翻后内侧旋转不稳定的疗效比较

Comparative study on effect of coronoid fixation with lateral collateral ligament repair versus hinged external fixator in treatment of elbow varus posteromedial rotational instability

目的比较冠状突内固定后修复外侧副韧带与使用铰链式外固定架治疗肘关节内翻后内侧旋转不稳定的临床效果。方法采用回顾性队列研究分析2011年1月～2015年6月手术治疗的34例肘关节内翻后内侧旋转不稳定，患者冠状突骨折均为O’DriscollⅡ型，其中1亚型6例，2亚型24例，3亚型4例。冠状突内固定后修复外侧副韧带15例（A组），冠状突内固定后使用铰链式外固定架19例（B组）。记录待术时间、手术时间及出血量，记录末次随访的肘关节活动范围、Mayo肘关节功能评分（MEPS）、Hastings＆Graham异位骨化分级。结果两组待术时间、手术时间及出血量差异均无统计学意义（P〉0．05）。患者均获随访，其中A组中位数30个月，B组40个月。末次随访时，B组屈肘功能[145°（135。～150°）]较A组[140°（130°～145°）]更好（P〈0．05）。两组伸肘角度、肘关节屈伸活动范围、前臂旋转范围、异位骨化分级差异均无统计学意义（P〉0，05）。两组MEPS（A组10例100分，3例90分，1例85分，1例70分；B组13例100分，1例90分，4例85分，1例80分）差异无统计学意义（P〉0．05）。结论在肘关节内翻后内侧旋转不稳定的治疗中，解剖复位并固定冠状突后修复外侧副韧带和使用铰链式外固定架均可获得良好的疗效。

Objective To compare the effect of coronoid fixation combined with lateral collateral ligament repair versus hinged external fixator in treatment of elbow varus posteromedial rotational instability. Methods This retrospective cohort research included 34 patients with elbow varus posteromedial rotational instability operated between January 2011 and June 2015. All patients had coronoid process fractures of O＇ Driscoll type Ⅱ （ six with subtype 1, 24 with subtype 2 and four with subtype 3 ）. Fifteen of the 34 patients were operated by coronoid fixation combined with lateral collateral ligament repair （Group A） and other 19 patients were operated by coronoid fixation combined with placing hinged external fixator （Group B）. Interval between injury and operation, operation time and blood loss were recorded. At final follow-up, elbow range of motion, Mayo elbow performance score （MEPS） and Hastings and Graham heterotopic ossification classification were measured. Results There were no significant differences in the interval between injury and operation, operation time and blood loss between the two groups （P 〉 0.05 ）. Median period of follow-up was 30 months in Group A and 40 months in Group B. Last follow-up showed flexion of the affected elbow in Group B [ 145° （135°-150°） ] was better than that in Group A [140° （130°-145°）] （P 〈 0. 05 ）, while between-group differences were insignificant in elbow extension, elbow extension-flexion, forearm pronation-supination and heterotopic ossification classification （P 〉0.05）. MEPS in Group A scored 100 in 10 patients, 90 in three, 85 in one and 70 in one; MEPS in Group B scored 100 in 13 patients, 90 in one, 85 in four and 80 in one. There was no signifieant difierence in MEPS between the two groups （ P 〉 0. 05 ）. Conclusion For treating elbow varus posteromedial rotational instability, either lateral collateral ligament repair or hinged external fixation after anatomic reduction and coronoid fixation can achieve good results.