肘关节三联征治疗方案的深入讨论

文题释义：肘关节三联征：桡骨头骨折、冠突骨折伴肘关节后或后外侧脱位于1996年被Hotchkiss命名为“terrible triad of the elbow”，国内习惯称之为肘关节恐怖三联征，常合并外侧韧带复合体、内侧韧带复合体起止部位的撕脱损伤及冠突骨折周围前关节囊破裂。由于近年来在恐怖三联征损伤的诊断和治疗方面取得了迅速进展，预后也相应地比过去好很多，国内很多专家建议直接将其命名为肘关节三联征。肘关节后外侧旋转不稳定：指由于外侧尺侧副韧带(外侧尺骨副韧带)损伤导致后侧半脱位或肱桡关节脱位，但不破坏近端尺桡关节，在1991由O’Driscoll等首次描述。目前对其的经典解释为：因摔倒致肘关节在轴向载荷下开始屈曲时，在身体在接近地面时肘关节受到外翻、旋后和轴向的应力综合作用，引起肘关节后脱位；同时导致的软组织损伤用“Horii环”解释：软组织破坏开始于外侧，并随着半脱位程度的增加向前后向内侧推进。背景：近年来肘关节三联征损伤的诊断和治疗方面取得了迅速进展。目的：简单介绍肘关节三联征的定义、相关基本解剖及稳定结构、损伤机制、分型，深入探讨其治疗方案。方法：第一作者检索PubMed、CNKI及万方数据库建库至2019年9月的文献，以“terribletriad of the elbow，elbowjoint，Fracture dislocation”为英文检索词，以“肘关节恐怖三联征，肘关节骨折脱位”为中文检索词，查阅大量近年肘关节三联征的相关文献，全面分析并总结其治疗策略。结果与结论：对于肘关节三联征损伤患者，术前必须仔细检查，认真分析影像学检查结果及打印3D模型，准确判断肘部骨性结构和韧带损伤程度；术中通常先通过单独外侧入路或内外联合入路重建桡骨头的稳定性、修复冠突骨折及外侧韧带复合体损伤后，然后行肘关节稳定性检测，以决定是否需要进一步修复内侧韧带复合体或应用铰链式外固定器来恢复肘关节的稳定性；术后积极行早期康复功能锻。通过上述系统治疗可相对减少术后并发症，加速骨折愈合，改善肘关节功能和患者生活质量。ORCID: 0000-0002-8244-4769(李宁鑫)中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

In-depth discussion on the treatment of terrible triad of the elbow

BACKGROUND:The diagnosis and treatment of the terrible triad of the elbow have achieved a breakthrough.OBJECTIVE:To introduce the definition,basic anatomy,stable structure,injury mechanism and classification of terrible triad of the elbow,and to discuss the treatment plan deeply.METHODS:The first author searched PubMed,CNKI and Wanfang databases for the articles published before September 2019.The keywords were“terrible triad of the elbow,elbow joint,fracture dislocation”in English and Chinese,respectively.A large number of articles concerning the terrible triad of the elbow in recent years were reviewed,and the treatment strategy was summarized.RESULTS AND CONCLUSION:For the terrible triad of the elbow,the operator must carefully check the patient before operation,carefully analyze the imaging examination results and three-dimensional printed model,and accurately judge the bone structure of the elbow and degree of ligament injury.During the operation,the stability of the radial head,the fracture of the coronoid process and the injury of the lateral ligament complex are usually reconstructed through a single lateral approach or a combination of internal and external approaches.Then,the stability of elbow joint is tested to determine whether it is necessary to repair the medial ligament complex or use the hinged external fixator to restore the stability of elbow joint.Early active rehabilitation is needed.The above systematic treatment can reduce postoperative complications,accelerate fracture healing,and improve elbow joint function and patients’quality of life.