手术治疗肘关节恐怖三联征28例疗效分析

Analysis on the curative effect of surgical treatment for 28 cases of terrible triad injury of elbow joint

目的评估手术治疗肘关节恐怖三联征的临床疗效。方法连续收集本院2020年1月-2022年1月收住并接受手术治疗28例肘关节恐怖三联征患者的临床资料,动态随访1年,观察患者的VAS疼痛评分、肘关节屈伸、前臂旋转范围、肘关节功能恢复情况和并发症发生情况。结果28例患者中男性19例、女性9例,平均年龄(31.28±11.52)岁。尺骨冠状突骨折Regan-Morrey I型5例、II型18例、III型5例;桡骨头骨折Mason I型9例、II型13例、III型6例。分别采用不同麻醉方式、手术入路和术式完成骨折内固定和韧带修复,随访结束时28例骨折均骨性愈合(100%),发生1例异位骨化(3.57%)被成功纠治(100%)。与术前比较,患者术后1年的肘关节疼痛(VAS评分:7.21±2.18 VS 2.01±0.21,P<0.001)、肘关节屈伸度(29.68±16.13 VS 130.81±18.95,P<0.001)、前臂旋前范围(10.63±8.25 VS 76.35±2.45,P<0.001)、旋后范围(10.21±8.89 VS 75.32±3.85,P<0.001)、肘关节功能(Mayo评分:38.36±18.63 VS 87.45±12.38,P<0.001)均显著改善。结论手术治疗肘关节恐怖三联征疗效显著,选择合适手术入路及手术模式重建肘关节的稳定性、术后早期康复锻炼,是获得满意疗效的关键。

Objective To evaluate the clinical effect of surgical treatment for terrible triad injury of elbow joint(TTIE).Methods Clinical data of 28 patients with triad injury of elbow joint admitted to our hospital from January 2020 to January 2022 for surgical treatment were continuously collected.The patients VAS pain score,elbow joint flexion and extension,forearm pronation and supination range,elbow joint function recovery and incidence of complications were followed-up one year and observed.Results Among the 28 patients,there were 19 males and 9 females,with an average age of 31.28±11.52 years.There were 5 cases of Regan-Morrey type I,18 cases of type II,and 5 cases of type III fractures of ulnar coronoid process fractures.There were 9 cases of Mason type I,13 cases of type II and 6 cases of type III of radial head fracture.Different anesthesia methods,surgical approaches and surgical methods were used to complete fracture internal fixation and ligament repair,and at the end of the follow-up,28 fractures had bone union(100%),and one case of ectopic ossification(3.57%)was successfully treated(100%).Compared to preoperative,patients elbow pain(VAS score:7.21±2.18 VS 2.01±0.21,P<0.01),elbow flexion and extension(29.68±16.13 VS 130.81±18.95,P<0.01),forearm pronation range(10.63±8.25 VS 76.35±2.45,P<0.01),supination range(10.21±8.89 VS 75.32±3.85,P<0.01)and elbow function(Mayo score:38.36±18.63 VS 87.45±12.38,P<0.01)were significantly improved after one year of surgical treatment.Conclusions Surgical treatment for terrible triad injury of elbow joint has a significant effect.The key to satisfactory efficacy is to choose the appropriate surgical approach and surgical mode to reconstruct the stability of the elbow joint and early postoperative rehabilitation exercise.