肘关节"恐怖三联征"合并尺骨鹰嘴骨折的手术治疗

目的 介绍肘关节"恐怖三联征"合并尺骨鹰嘴骨折的手术方法和疗效.方法 肘关节"恐怖三联征"合并尺骨鹰嘴骨折患者12例,男8例,女4例;年龄21~75岁,平均40.4岁.桡骨头骨折按Mason分型:Ⅱ型7例,Ⅲ型5例;因合并肘关节脱位,按Johnston-Mason分型均为Ⅳ型.冠突骨折按Regan-Morrey分型:Ⅰ型2例,Ⅱ型4例,Ⅲ型6例.尺骨鹰嘴骨折按Mayo分型Ⅱa型2例,Ⅱb型2例,Ⅲa型2例,Ⅲb型6例.9例肘关节后脱位,3例为前脱位.12例均行手术治疗,冠突、鹰嘴骨折行内固定;桡骨头骨折行内固定、桡骨头切除、金属桡骨头置换,修复内、外侧副韧带.术后石膏托维持肘关节屈曲90°,前臂中立位固定3周.结果 8例(66.7%)患者获得随访,随访时间3~36个月.平均16.4个月.骨折全部愈合,愈合时间10~16周,平均14.2周.Broberg-Morrey评分为55~95分,平均88分,优4例,良2例,可1例,差1例,优良率为75.0%.肘关节屈伸范围为70°~150°,平均127.5°;前臂旋转范围为65°~155°,平均122.5°.结论 肘关节"恐怖三联征"合并尺骨鹰嘴骨折为高能量损伤,关节严重不稳定,必须重建骨关节及软组织的解剖结构,恢复肘关节稳定性.

Surgery treatment for the terrible triad of the elbow associated with olecranon fracture

Objective To introduce the method of treatment for the terrible triad of the elbow associated with olecranon fracture. Methods 12 consecutive patients suffered the terrible triad of the elbow associated with olecranon fracture were treated. There were 8 men and 4 women with a mean age of 40.4 years, range 21 to 75. According to Mason classification, radial head fracture were type Ⅱ in 7 cases, and type Ⅲ in 5 cases (according to Johnston-Mason classification, 12 cases were type Ⅳ). They were treated with internal fixation, radial head resection, metal prosthesis replacement. Coronoid fracture were type Ⅰ in 2 cases, type Ⅱ in 4 cases, type Ⅲ in 6 cases according to Regan-Morrey classification. According to Mayo classification of olecranon fracture, 2 cases were type Ⅱ a, 2 cases type Ⅱ b, 2 cases type Ⅲ a and 6 cases type Ⅲ b. 3 were anterior dislocation of the elbow and 9 were posterior dislocation. All olecranon and coronoid fractures were treated with internal fixation. The medial and lateral collateral ligments were repaired. A plaster was applied for 3 weeks after operation, in position with elbow flexion at 90° and forearm rotation in neutral. Results 8 patients (66.7%) were followed-up for 16.4 months (range, 3 to 36 months) with healed fractures, the mean duration for 14.2 weeks (range, 10 to 16 weeks). According to Broberg-Morrey function rate scale, the mean score was 88 ((range, 55 to 95), and the rate of excellent and good was 75.0%. The total range of elbow flexion-extension was 127.5°(70°-150°) and forearm rotation was 122.5°(65°-155°). Conclusion The terrible triad of the elbow associated with olecranon fracture is a high-energy trauma and very unstable. The surgical treatment must be done to reestablish anatomic form and restore stability of the elbow.