不同手术时机对肘关节“恐怖三联征”疗效的影响

目的探讨不同手术时机对肘关节"恐怖三联征"疗效的影响。方法对2009年1月至2012年6月收治的45例肘关节恐怖三联征患者按手术时间分为急诊手术组(伤后24 h内)、早期手术组(伤后5~14 d)、延期手术组(伤后17~26 d),分别为12例、17例、16例,采用Pugh-McKee标准术式治疗,术后12个月按照Mayo功能评分标准进行疗效评价。结果其中40例获得随访(早期手术组丢失3例,延期手术组丢失2例),随访时间12~24个月(平均16.9个月)。急诊手术组肘关节平均屈伸弧度为118.1°(76°~145°),前臂平均旋转弧度为137.5°(67°~179°),Mayo评分平均88.3分(63~100分)。早期手术组肘关节平均屈伸弧度为119.7°(77°~145°),前臂平均旋转弧度为136.5°(67°~178°),Mayo评分平均89.2分(65~100分)。延期手术组肘关节平均屈伸弧度为98.5°(45°~120°),前臂平均旋转弧度为110.2°(60°~155°),Mayo评分平均78.3分(57~93分)。动态观察三组患者前臂旋转、屈曲功能,发现急诊组术后3个月好于其他两组,但在第6、12个月时急诊组与早期组结果相当,并均好于延期手术组。结论急诊或早期手术治疗肘关节"恐怖三联征"疗效优于延期手术治疗。对于肘关节"恐怖三联征"患者,应尽早进行手术治疗。

Influence of Surgery Timing on the Function Recovery of the Terrible Triad Injury of Elbow

Objective To investigate the affection of surgical timing on the functional rehabilitation of terrible triad injury of elbow. Methods In 2009-2010,45 patients in our hospital were divided into emergency surgery group 12 cases（within 24 hours after injury）,early surgery group 17 cases（5 ～ 14 days after injury）,delayed surgery group 16 cases（injury after 17～ 26 days）according the operation time. All the patients were treated by Pugh-McKee standard technique,and evaluated by Mayo function score after 12 months follow up. Results 40 cases were followed up（early surgery group lost three cases,de-layed surgery group lost two cases）for 12 ～ 24 months/（mean 16. 9 months）In the emergency surgery group the mean elbow flexion arc was 118. 1°（76° ～ 145°）. The average forearm rotation radians wsa 137. 5°（67° ～ 179°）. Mayo score was 88. 3 points（63 to 100 points）. In the early surgery group the average elbow flexion arc was 119. 7°（77° ～ 145°）. The average fore-arm rotation radians was 136. 5°（67° ～ 178°）. Mayo score was 89. 2 points（65 to 100 points）. The delayed surgery group,the mean elbow flexion arc was 98. 5°（45° ～ 120°）. The average forearm rotation radians was110. 2°（60° ～ 155°）. Mayo score was 78. 3 points（57 to 93 minutes）. Continuous observation found that the flexion and forearm rotation in emergency group was better than the other two groups on three months postoperation. But the result was similar b＆#234;tween emergency group and early group,and were better than delayed surgery group on six and twelve months postoperation. Conclusion Early or emer-gency surgical treatment for terrible triad injury of elbow are more effective than delayed surgery.