单一外侧入路治疗肘部损伤"三联征"的修复技巧及疗效分析

目的 探讨采用单一肘关节外侧入路治疗肘部损伤"三联征"的手术扩大显露、修复技巧及临床疗效.方法 对2007年5月至2010年3月收治的6例肘部损伤"三联征"患者采用单一肘关节外侧入路,由深至浅依次修复下列结构:冠状突骨折、桡骨头骨折、外侧副韧带、伸肌总腱起点.并用自创的方法对冠状突骨折进行扩大显露,直视下复位与牢靠固定,对肘关节外侧结构的撕裂进行有效修复.本组患者均未做肘关节内侧副韧带的探查与修复.随访时采用Mayo肘关节功能评分(MEPS)对患者肘关节功能进行评价.结果 本组患者随访3～24个月,平均11个月.所有患者骨折均获骨性愈合,肘部屈伸活动度105°～135°,平均120.0°;前臂旋转活动度150°～170°,平均168.3°;MEPS评分93～95分,平均93.3分,均为优.所有患者均无伤口感染,伤口一期愈合.结论 单一肘关节外侧入路结合相应手术技巧的改进,解决了肘部损伤"三联征"中冠状突骨折复位与固定的疑难问题,对肘关节外侧结构的修复也更加简单、牢靠,是一种临床可行且疗效满意的手术方式.

Terrible triad of the elbow treated with a single lateral approach: surgical technique and outcome

Objective To discuss surgical technique and clinical outcome of the treatment of terrible triad of the elbow with a single lateral approach. Methods Six patients with terrible triad of the elbow were treated with a single lateral approach from May 2007 to March 2010. We used a single lateral approach to repair the damaged structures. Our new technique involved extensile exposure and solid internal fixation of the coronoid and radial head fractures under direct visualization, followed by complete repair of the lateral collateral ligament complex of the elbow. All patients were followed up for a mean time of 11 months (range,3 to 24 months) and evaluated with Mayo elbow performance score (MEPS). Results All the 6 patients obtained excellent MEPS scores. No patient complained of pain or instability of the elbow joint at the last follow-up. Conclusions To repair the damaged structures in terrible triad of the elbow, a single lateral approach with the surgical technique designed by us is recommendable. Satisfactory results can be achieved as long as it is not necessary to repair the medial collateral ligament.