修复前关节囊在"肘关节恐怖三联征"手术治疗中的疗效观察

目的探讨修复前关节囊在"肘关节恐怖三联征"手术治疗中的疗效。 方法自2015年5月至2017年12月苏州大学附属瑞华医院手外科采用手术修复前关节囊治疗8例肘关节恐怖三联征患者,根据影像学评价观察骨折愈合情况。采用Mayo肘关节功能评分评估肘关节功能情况。 结果所有患者均获得6~36个月随访,平均18个月。切口均Ⅰ期愈合。骨折均愈合,时间为8~12周,平均10周。根据术后6个月随访,肘关节屈位0°~15°,伸位130°~145°,平均活动范围为115°,旋前60°~90°,旋后40°~70°,平均旋转范围120°。术后无骨折块移位、内固定失效、锁定接骨板螺钉松动或断裂、切口感染、异位骨化等并发症发生。肘关节功能恢复良好,采用Mayo肘关节功能评分：优6例,良2例。 结论在肘关节恐怖三联征时修复前关节囊,恢复肘关节的稳定性,并发症少,骨折愈合快,及早配合正规的康复锻炼,肘关节功能恢复好,疗效确切。

Observation on the curative effect of anterior capsule repair in the surgical treatment of terrible triad of the elbow

BackgroundElbow is the most important joint of upper limb, which mainly completes flexion, extension and forearm rotation activities. Radial head fracture, coronal process fracture and elbow dislocation often occur after elbow injury. When the posterior dislocation of elbow joint is combined with radial head fracture and ulnar coronoid process fracture, it is called "terrible triad of the elbow" . Objective To investigate the efficacy of anterior capsule repair in the surgical treatment of "terrible triad of the elbow" . MethodsFrom May 2015 to December 2017, 8 patients with terrible triad of the elbow were treated by anterior joint capsule repair, and the bone healing was observed through imaging evaluation. The elbow joint function was assessed using Mayo elbow performance score. ResultsAll patients were followed up for 6 to 36 months with an average of 18 months. The incisions healed at the first stage. The fracture healing time ranged from 8 to 12 weeks with an average of 10 weeks. According to the follow up of 6 months after operation, the range of elbow flexion was 0°-15°, the range of elbow extension was 130°-145°, the average range of elbow motion was 115°, the range of elbow pronation was 60°-90°, the range of supination was 40°-70°, the average range of elbow rotation was 120°. There were no complications such as fragment displacement, internal fixation failure, locking plate and screw loosening or breakage, incision infection, heterotopic ossifications, etc. All the elbows recovered well, and according to Mayo elbow performance, there were 6 excellent cases and 2 good cases. ConclusionsThe stability of elbow joint is restored in the treatment of terrible triad of the elbow with anterior joint capsule repair. The complications are less, and the fracture healing is fast. With early regular rehabilitation exercise, the elbow joint function recovers well and the curative efficacy is exact.