肘关节“三联征”的诊治分析

目的:探讨肘关节"三联征"的诊疗要点及治疗效果。方法:回顾性分析2001年6月至2009年6月7例肘关节"三联征"的临床资料及随访结果。男6例,女1例;年龄20～68岁,平均36.5岁;均为新鲜骨折。全部病例住院后先行手法复位肘关节脱位,石膏固定,7～10d后手术治疗。均采用外侧切口入路,依次从深层至浅层修复冠状突骨折、前方关节囊、桡骨头骨折、外侧副韧带、伸肌总腱起点,冠状突骨折和桡骨头骨折复位后根据骨块大小采用不同方法固定。疗效按Mayo肘关节功能评分(Mayoelbowperformancescore,MEPS)评定。结果:本组平均随访16.3个月(5～36个月),骨折平均愈合时间4.5个月(3～6个月),异位骨化4例。肘关节活动度-20°～130°,平均106.5°;前臂旋转度70°～140°,平均121°。本组疗效优2例,良0例,一般4例,差1例。1例桡骨头切除,冠状突骨折复位后克氏针自后向前固定,术后拍X线片示冠状突骨折块发生分离移位,肘关节呈半脱位状态,随访时肘关节仍不稳定,关节功能差。结论:肘关节"三联征"应积极手术治疗,骨与软组织损伤并重处理,结合术后早期功能练习是获得良好疗效的关键。

Diagnosis and treatment of terrible triad of elbow

Objective: To study diagnosis and treatment methods of terrible triad of elbow. Methods: From June 2001 to June 2009,7 patients with terrible triad of elbow were reviewed. Among the patients,6 patients were male and 1 patient was female,ranging in age from 20 to 68 years,averaged 36.5 years. All the fractures were fresh. All the patients were treated through a single lateral approach. The general approach was used to repair the damaged structures sequentially from deep to superficial,from coronoid to anterior capsule,to radial head,lateral ligament complex,and common extensor origin. The coronoid fractures and the radial head fractures were fixed with different methods according to fragments. The curative effiency were evaluated by Mayo elbow performance score(MEPS). Results: All the patients were followed up,and the duration ranged from 5 to 36 months,with a mean of 16.3 months. All the fractures were healed,and the healing time ranged from 3 to 6 months after operation(averaged 4.5 months). Four patients had heterotopic ossificatio. According to evaluation criteria,2 patients got an excellent result,4 fair and 1 bad. The average range of motion in elbow flexion-extension were 106.5 degrees(from -20 to 130 degrees),and the range of motion in forearm pronation-supination were 121 degrees(from 70 to 140 degrees). The patient with bad results were treated with radial head excised,and Kirschner fixation from posterior to anterior after reduction,which was found separate dislocation of the coronoid fracture on the X-ray after operation,and subluxation and instability of the elbow joint. Conclusion: The patients with terrible triad of elbow should be treated with operation actively. Follows are key to get an excellent result:treatment of bone and soft tissues at the same time,early rehabilitation after operation.