铰链式支架外固定下肘关节恐怖三联征侧副韧带的修复探讨

A study on the repairment of the collateral ligament of terrible triad of the elbow under hinged external fixator

目的铰链式支架在肘关节恐怖三联征中的应用,已得到创伤骨科医师的广泛接受。文中在联合应用铰链式支架的情况下,对肘关节恐怖三联征的侧副韧带修复进行探讨。方法选取2011年6月至2016年8月佛山市中医院创伤骨科三联征患者23例。手术中均首先进行尺骨冠状突骨折和桡骨头骨折的复位固定,后根据外侧副韧带复合体(LCLC)的损伤程度及肘关节的稳定性决定其修复,内侧副韧带复合体(MCLC)不修复,最后采用铰链式支架固定肘关节于屈肘90°、前臂中立位。平均随访时间13.7(8~26)个月,测量肘关节屈伸和前臂旋转弧度,采用HSS评分标准评定肘关节功能。结果23例患者末次随访时平均屈伸弧度(122.2±11.9)°,LCLC止点重建和未重建屈伸弧度分别为(120.3±13.1)°、(125.6±9.0)°;平均旋转弧度(118.7±14.3)°,LCLC止点重建和未重建屈伸弧度分别为(116.0±13.1)°、(123.8±16.0)°。HSS评分(82.0±12.6)分。优良率78.3%。1例出现桡骨头半脱位,1例出现桡骨头骨不连,未发生复发性肘关节后脱位,6例出现肘关节异位骨化。结论在铰链式支架外固定下不必常规修复MCLC,同时,未引起肘关节明显不稳定的LCLC损伤可不行修复,配合铰链式支架外固定能获得良好疗效。

Objective The application of hinged scaffold in the terrible triad of the elbow has been widely accepted by orthopedic trauma physicians. We discussed whether to repair the collateral ligament or not of terrible triad of the elbow under hinged external fixator in this study.Methods 23 patients with terrible triad of the elbow, who had been admitted in Foshan Hospital of traditional Chinese Medicine from June 2011 to August 2016 were selected. In the surgeries, we firstly repaired and fixed the coronoid and radial head fractures, and the repairments of the lateral collateral ligament complex （LCLC） was based on the severity of injury and the stability of the elbow joint. All the patients were treated with hinged external fixator in flexion 90°, forearm neutral position and the medial collateral ligament complex （MCLC） was not repaired. The patients were followed up from 8 to 26 months with an average of 13.7 months. Elbow flexion and extension amplitude and forearm rotation amplitude were measured at the time of follow-up. The clinical effects were evaluated according to HSS scoring of elbow joint function.Results Their average elbow range of flexion and extension at the last follow-up is （122.2±11.9）°,LDLC insertion site reconstruction and non-reconstruction has the flexion and extension range of （120.3±13.1）°, （125.6±9.0）°; their average forearm rotation amplitude was （118.7±14.3）°, LDLC insertion site reconstruction and non-reconstruction has the forearm rotation amplitude of （116.0±13.1）°, （123.8±16.0）°. HSS score was （82.0±12.6） points.The Results were excellent in 7 cases, good in 11. The excellent-good rate was 78.3%. After surgery, 1 case developed radial head subluxation, 1 case developed nonunion of radial head without recurrent dislocation of elbow joint, 6 cases developed ectopic ossification of the elbow joint.Conclusion With the use of hinged external fixator, it is not necessary to repair the MCLC. And the LCLC injury cannot be repaired when it does not cause severe instability of the elbow, with the use of hinged external fixator can get a good effect.