| 肘关节“三联征”的手术疗效分析 |
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Received:May 25, 2010
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| 期刊信息：《中国骨伤》2010年23卷，第9期，第650-653页 |
| DOI：10.3969/j.issn.1003-0034.2010.09.003 |
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目的：回顾分析手术治疗肘关节后脱位合并桡骨头和尺骨冠状突骨折的临床疗效。
方法：2004年1月至2009年3月，收治9例“三联征”患者。其中男7例，女2例；左侧4例，右侧5例；年龄21～67岁，平均41.2岁。桡骨头骨折根据Schatzker-Tile分类：Ⅰ型4例，Ⅱ型3例，Ⅲ型2例。尺骨冠状突骨折根据Regan-Morrey分类：Ⅰ型2例，Ⅱ型5例，Ⅲ型2例。手术方式采用由深入浅的层次修复，依次为冠状突骨折、前关节囊、桡骨头骨折、外侧关节囊和伸肌总腱起点。如存在外翻不稳定，需要修复内侧副韧带。术后肘关节完全旋前位屈曲90°固定7～10 d,6周以内避免进行完全伸直旋后位功能锻炼(这种体位容易导致肘关节旋后不稳定).8周可以进行肌力锻炼，3个月左右可以恢复日常生活。
结果：所有患者得到随访，时间6个月～5年，平均(31±6)个月。术后3个月：屈伸度为80°～110°，平均(102±3)°；前臂旋转度100°～150°，平均(135±6)°。根据Mayo肘关节评分标准，优5例，良3例，一般1例，差0例。其中3例术后6个月出现异位骨化，2例不影响功能未进行处置，1例影响屈伸功能，给予外侧入路切除骨化块，术后早期功能锻炼，MEP评分由一般升为良。
结论：肘关节“三联征”的治疗关键是恢复正常的肱桡、肱尺关节解剖关系，修复损伤的韧带及关节囊，保证肘关节的稳定。如果软组织损伤严重可以采用铰链式外固定架固定促进软组织的修复，同时并不影响肘关节的早期功能锻炼，避免肘关节僵硬。 |
| [关键词]:肘关节 桡骨骨折 尺骨骨折 功能恢复 骨折固定术 |
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| Clinical outcome of surgical treatment of terrible triad of elbow |
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Abstract:
Objective: To evaluate the clinical outcome of surgical treatment of the posterior dislocation of the elbow with coroniod and radial head fractures.
Methods: From January 2004 to March 2009,9 patients with terrible triad of the elbow were reviewed. There were 7 males and 2 females(4 left elbows and 5 right elbows),with an average age of 41.2 years,ranged from 21 to 67 years. The radial head fractures were classified according to the Schatzker-Tile criteria:4 patients had the fractures of type Ⅰ，3 patients had type Ⅱ and 2 patients had type Ⅲ。 The ulnar coronoid fractures were classified according to the Regan-Morrey criteria:2 patients had the fractures of type I,5 patients had type Ⅱ and 2 patients had type Ⅲ。 The general approach was used to repair the damaged structures sequentially from deep to superficial,through coronoid,anterior capsule,radial head,and lateral ligament complex to common extensor origin. If there was valgus instability in the elbow after the operation,the medial collateral ligament should be repaired with nonabsorption sutures. The plaster was applied for 7 to 10 days with elbow flexion in 90 degrees and the forearm in full pronation. Unrestricted motions and rehabilitation began at the 8th week after operation. Recovery of regular occupation depended on the degree of physical activity required,and it typically took 3 months for heavy physical laborers to return to work.
Results: All the patients were followed up from 6 months to 5 years,with a mean duration of (31±6) months. At the 3rd month after operation,the mean rang of motion in flexion and extension of the elbow was (102±3)° (ranged from 80° to 110°),and the mean range of motion in pronation and supination of the forearm was(135±6)°(100° to 150°). According to the criteria of the Mayo scoreing system,the results were excellent in 5 cases,good in 3 cases,and fair in 1 case. Three patients had heterotopic ossification at the 6th month after operation. Among them,2 patients had no effects on elbow function and were not treated,1 patient had effects on flexion-extension of the elbow and was treated with resection of heterotopic ossification through lateral approach combined with early rehabilitation,the MEP score of the patient improved from fair to good.
Conclusion: The key points for treating the terrible triad of the elbow are to restore the elbow normal anatomy and early rehabilitation to avoid the elbow stiff. |
| KEYWORDS:Elbow joint Radius fractures Ulna fractures Recovery of function Fracture fixation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 荀宝通,智润林,林源,曲铁兵.肘关节“三联征”的手术疗效分析[J].中国骨伤,2010,23(9):650~653 |
| 英文格式: | XUN Bao-tong,ZHI Run-lin,LIN Yuan,QU Tie-bing.Clinical outcome of surgical treatment of terrible triad of elbow[J].zhongguo gu shang / China J Orthop Trauma ,2010,23(9):650~653 |
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