前内侧入路结合外侧入路内固定治疗肘关节三联征

目的：探讨前内侧入路结合外侧入路治疗肘关节三联征的临床疗效。方法：2009年11月至2013年3月,采用前内侧入路结合外侧入路治疗肘关节三联征17例,男11例,女6例;年龄22~68岁,平均36.6岁;左侧10例,右侧7例。术中前内侧入路采用肘关节前内侧切口桡侧腕屈肌和掌长肌之间劈开指浅屈肌入路对冠状突骨折进行复位内固定,外侧入路采用肘关节外侧Kocher入路,沿肱骨外上髁在肱三头肌和肱桡肌间隙切开,向下在后侧的肘肌和尺侧腕伸肌间隙切开,显露外侧副韧带、关节囊和桡骨小头,采用微型钢板及螺钉固定桡骨小头,用带线锚钉修复外侧副韧带复合体。术后根据Mayo肘关节功能评分评价肘关节功能。结果：所有患者获得随访,时间13~24个月,平均12.4个月。所有患者术后末次随访时肘关节平均屈曲（134.0±8.8）°,平均伸直受限（6.4±2.3）°。末次随访时Mayo肘关节功能评分：疼痛42.4±5.9,屈伸活动17.6±2.6,关节稳定性9.7±1.2,日常生活功能22.1±2.5,总分91.8±7.9;优13例,良4例。术后2例出现一过性尺神经麻痹症状,异位骨化1例,无感染、骨折不愈合、肘关节不稳、脱位及僵硬等并发症发生。结论：前内侧入路结合外侧入路治疗肘关节三联征疗效可靠,术中能充分显露骨折部位,利于内固定植入,带线锚钉修复韧带可使关节获得充分稳定性,利于早期功能锻炼。

Treatment of terrible triad of elbow with open reduction and internal fixation through anteromedial approach combined with lateral approach

Objective: To study therapeutic effects of anteromedial approach combined with lateral approach for the treatment of terrible triad of elbow.Methods: From November 2009 to March 2013,17 patients with terrible triad of elbow were treated through anteromedial approach combined with lateral approach. There were 11 males and 6 females,with an average age of 36.6 years old,ranging from 22 to 68 years old. Ten patients had fractures in the left side and 7 patients had fractures in the right side. All of which were close fractures. Coronoid process fractures were reduced and treated with internal fixation through the anteromedial approach,and the incision was located between radiocarpus and cubitalis grailis. In order to expose the lateral collateral ligament joint capsule and capitulum rodii,Kocher approach was used with the incision between triceps brachii muscle and brachioradialis muscle along condylus lateralis humeri,down to posterior side between anconeus muscle and extensor carpi ulnaris muscle. Then capitulum radii fractures were treated with internal fixation using miniature plates and screws,and lateral collateral ligament complexes were repaired using fasciole rivets. Mayo elbow performance score(MEPS) was used to evaluate clinical effects at the latest follow-up.Results: All the patients were followed up,and the duration ranged from 13 to 24 months,with a mean of 12.4 months. At the latest follow-up,the average flexion angle of all patients was (134.0±8.8)°;the average extension angle was(6.4±2.3)°. According to the Mayo criteria system,the average total score was 91.8±7.9,including pain score 42.4±5.9,range of motion score 17.6±2.6,joint stability score 9.7±1.2,and functional score 22.1±2.5;13 patients got an excellent result and 4 good. Two patients had transient ulnar nerve palsy,and 1 patient had heterotopic ossification. There were no complications such as infection,nonunion,elbow residual instability,dislocation and elbow stiffness.Conclusion: The operation through anteromedial approach combined with lateral approach for the treatment of terrible triad of elbow has advantages of providing both bone and soft-tissue stability simultaneously,allowing early exercise and improving early functional recovery.