肘关节“恐怖三联征”中内侧副韧带及合并损伤的治疗策略

目的 探讨肘关节“恐怖三联征”中内侧副韧带及合并损伤的治疗策略.方法 回顾性分析2010年2月至2012年4月治疗的21例肘关节“恐怖三联征”患者病历资料,男17例,女4例；年龄16～57岁,平均37.6岁；左侧12例,右侧9例.术前常规行MR检查并根据其结果制定内侧副韧带及合并损伤的治疗策略.对于MRI提示没有损伤或部分撕裂但内侧副韧带前束完整的患者,术中并不常规探查修补；对于MRI提示内侧副韧带前束起、止点撕脱或体部断裂者,则常规采用前内侧入路探查修补,对于起、止点撕脱者采用锚钉予以缝合,对于体部断裂者则采用“8”字缝合,合并屈肌-旋前圆肌复合体损伤者也同时予以缝合修补.术后予以可屈性支具固定,无一例患者采用外固定支架固定.结果 术后随访平均12.4个月(6～26个月)°所有患者术后末次随访时肘关节平均屈伸活动度为135.2°±10.2°,平均伸直受限6.7°±2.2°,平均屈曲142°±11.0°.Mayo肘关节功能评分平均为92分(85～100分),17例患者功能为优,4例为良.术后并发症包括一过性尺神经麻痹3例、异位骨化2例、迟发性尺神经炎1例,无肘关节残留不稳定、脱位、肘关节僵硬等并发症.结论 对于内侧副韧带前束起、止点撕脱或体部断裂者应常规采用内侧入路探查修补,有利于恢复肘关节即刻稳定性.

The treatment of medial collateral ligament and combined injury in the terrible triad of elbow

Objective To discuss the treatment strategy of medial collateral ligament and combined injury in the terrible triad of elbow. Methods The data of 21 patients with terrible triad of elbow who received treatment from February 2010 to April 2012 was retrospectively analyized .There are 17 males and 4 females with12 cases left and 9 right elbows. The average age of them was 37.6 years (16-57). MRI examination was performed routinely, and used as guidance of treatment strategy of medial collateral ligament and combined injury. For the patients without or with partial damage of anterior bundle of medial collateral ligament(AMCL) injury while the continuity of ligament remains complete in MRI image, exploration and repair of the medial collateral ligament is not conventional. For the patients with MRI image showing AMCL avulsion or body disruption, we routinely used antero-medial approach to explore and repair, suture-anchors were used for suture the bony avulsion of the medial collateral ligament, body disruption of ligament and combined flexor-pronator teres complex injury were also be suture repaired. None of the patients used hinged external fixator during operation. A hinged brace was applied after operation. Results All patients were followed up for an average of 12.4 months (6-26). At the last follow-up, the average range of motion of the elbow was 135.2 ±10.2 degrees, average straight limited degrees, 6.7±2.2 degrees, an average of 142±11.0 degrees of flexion. Mayo elbow performance score was 92 points (85-100). 17 cases were excellent and 4 were good. Complications included: a transient ulnar nerve palsy in 3 cases, heterotopic ossification in 2 cases, tardive ulnar neuritis in 1 case, no elbow residual instability, dislocation, elbow stiffness and other complications. Conclusion Anterior bundle of medial collateral ligament avulsion or body disruption should be routinely suture repaired, which is in favor of restoring elbow immediate stability favoring restore elbow immediate stability.