| 手术治疗肘部损伤三联征的病例对照研究 |
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投稿时间：2013-01-15
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| 期刊信息：《中国骨伤》2014年，第27卷，第1期，第41-45页 |
| DOI：10.3969/j.issn.1003-0034.2014.01.011 |
| 基金项目:四川省青年基金（编号：09ZQ-026-078） |
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中文摘要:
目的： 回顾性分析应用外固定支架结合有限内固定、周围软组织修复重建与切开复位内固定手术加石膏外固定治疗肘部损伤三联征的疗效。
方法： 2003年1月至2011年6月，采用铰链式外固定支架和石膏外固定治疗肘部损伤三联征26例。其中单臂铰链式外固定支架结合有限内固定、周围软组织修复和重建14例（支架组），男8例，女6例；年龄20～62岁，平均（33.60±8.53）岁；外固定支架平均使用7.5周（6～8周），术后第1天开始前臂旋转功能锻炼，4～6 d行肘关节屈伸活动。切开复位内固定加石膏外固定12例（石膏组），男8例，女4例；年龄21～63岁，平均（34.80±7.41）岁；术后石膏平均固定时间30.4 d，4～6周后拆除石膏托行前臂牵引下的被动锻炼及主动功能锻炼。以肘关节功能（JOA）评分标准进行肘关节功能评定。
结果：所有病例获完整随访，时间12～36个月，平均18.6个月。石膏组骨折愈合时间平均（8.6±3.1）周，支架组平均（9.0±2.7）周，差异无统计学意义（t=1.47，P>0.05）.石膏组和支架组患者术后随访时JOA评分在功能和活动度两方面差异有统计学意义，支架组评分高于石膏组；而在疼痛、关节动摇性和畸形方面差异无统计学意义。支架组术后肘关节功能恢复优于石膏组（t=-2.66，P<0.01）.
结论：铰链式外固定支架能增加肘关节侧方稳定性，有利于维持骨折脱位的复位，保证早期安全的功能锻炼，预防关节僵硬，减少异位骨化的发生。在肘部损伤三联征的手术治疗中，与其他治疗方式相比，对早期肘关节功能的恢复更具优越性。 |
| 【关键词】肘关节 石膏,外科 外固定器 病例对照研究 |
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| Case-control study on the operative treatment for terrible triad of the elbow |
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ABSTRACT
Objective: To retrospectively analyze therapy comparison between hinged external fixator combining with internal fixation,soft tissue repair and plaster fixation after routine surgery for terrible triad of the elbow.
Methods: From January 2003 to June 2011,26 patients with terrible triad of the elbow（posterior dislocation associated with fracture of both the radial head and the ulnar coronoid process） were treated respectively by unilateral hinged external fixator and plaster fixation. Fourteen patients were treated with external fixator combining with internal fixation,soft tissue repair and reconstruction,including 8 males and 6 females,ranging in age from 20 to 62 years with an average of（33.60±8.53） years. The mean time of fixation was 7.5 weeks（ranged,6 to 8 weeks）,and forearm rotation exercise was performed after the first day of operation,elbow flexion and extension activities after 4 to 6 days. Twelve patients were treated with plaster external fixation combining with open reduction and internal fixation,including 8 males and 4 females,ranging in age from 21 to 63 years with an average of（34.80±7.41） years. The mean time of plaster fixation was 30.4 days,and functional exercise was carried out after 4 to 6 weeks of plaster removal. JOA assessment score were used to evaluate the elbow joint function.
Results: All the patients were followed up,and the duration ranged from 12 to 36 months,with an average of 18.6 months. The mean time of fracture healing was（8.6±3.1） weeks in plaster group and（9.0± 2.7） weeks in fixator group,with no statistical difference between the two groups（t=1.47,P>0.05）. The function and arc of motion in plaster group and fixator group showed significant difference. While the pain,articular instability and deformity showed no statistical difference. The total assessment score between two groups indicated markedly difference（t=-2.66,P<0.01）.
Conclusion: Hinged external fixator can enhance lateral stability of elbows,benefit the reduction of fracture dislocation,guarantee early and safe functional exercise,prevent elbow stiffness,and reduce heterotopic ossification. In treating terrible triad of the elbow,the hinged external fixator is superior to other therapies with respect of improving the function of elbow joint. |
| KEY WORDS Elbow joint Casts,surgical External fixators Case-control studies |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 尹毅,赵燕.手术治疗肘部损伤三联征的病例对照研究[J].中国骨伤,2014,27(1):41~45 |
| 英文格式: | YIN Yi,ZHAO Yan.Case-control study on the operative treatment for terrible triad of the elbow[J].zhongguo gu shang / China J Orthop Trauma ,2014,27(1):41~45 |
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