肘关节脱位伴尺骨冠突和桡骨小头骨折的手术治疗探讨  

A tentative study on the surgical treatment of terrible triad of the elbow

作　　者：廖苏平[1] 吴波[1] 危蕾[1] 刘俊[1] 冯俊[1] 勘武生[1] 

机构地区：[1]华中科技大学同济医学院附属普爱医院上肢骨科,武汉430033

出　　处：《临床外科杂志》2014年第3期195-197,共3页Journal of Clinical Surgery

摘　　要：目的 探讨肘关节恐怖性三联征的手术方法及疗效.方法 对18例肘关节恐怖性三联征患者行手术治疗.18例均为闭合性损伤.桡骨小头骨折按Mason法分类：Ⅰ型1例,Ⅱ型7例,Ⅲ型10例.尺骨冠突骨折按Regen-Morrey法分类：Ⅰ型3例,Ⅱ型12例,Ⅲ型3例.尺骨冠突骨折应用微型螺钉或可吸收钉固定14例,可吸收钉加克氏针固定4例,桡骨小头骨折应用微型螺钉或可吸收螺钉固定17例,其中加克氏针固定9例,桡骨小头假体置换1例.应用阔筋膜或掌长肌腱移植重建内侧副韧带前束12例,重建外侧副韧带3例,内、外侧副韧带直接修补缝合6例.结果 随访12～48个月,平均18个月.所有病例伤口一期愈合,无一例发生神经损伤,无骨折再移位.肘关节屈伸、前臂旋转功能均有不同程度的恢复,均重返原工作岗位.根据Morrey等确定的肘关节功能评价标准：优5例,良12例,可1例,优良率94%.结论 应用微型螺钉或可吸收螺钉固定尺骨冠突和桡骨小头,游离肌腱移植重建肘关节内、外侧副韧带,恢复肘关节的动态稳定和静态稳定是治疗肘关节恐怖性三联征的一种有效的手术方法.Objective To explore the surgical treatment methods of terrible triad of the elbow and their efficacy. Methods Surgical treatments were applied on 18 patients suffering from terrible triad of the elbow from June 2007 to June 2010,including 11 males and 7 females,aged from 11 to 66 years old, with an average age of 37.2. Seven cases were with terrible triad of the elbow on the left side and 11 cases on the right side, and all 18 cases were closed injuries. Based on the Mason Law,radial head fractures can be classified into type Ⅰ in 1 case,type Ⅱ in 7 cases and typem in 10 cases. According to the Regen-Morrey method,ulnar coronoid fractures can be divided into type Ⅰin 1 case,type Ⅱ in 12 cases and typeⅢ in 3 cases, among which 14 cases were fixed with mini or absorbable screws and 4 cases with absorbable screws and K-wire fixation. Seventeen cases of radial head fractures were fixed with mini or absorbable screws,among which 9 cases were fixed with K-wire fixation and 1 case had radial head prosthesis. Through application of fascia lata or palmaris longus tendon graft, the anterior bundle of medial collateral ligament of 12 patients and the lateral collateral ligament of 3 patients were reconstructed, and the medial and lateral collateral ligaments of 6 patients were repaired with direct suture. Results Follow-up investi- gation lasted for 12 -48 months,with an average of 18 months. Wounds had primary healing in all cases with no nerve injury or fracture re-displacement. Flexion and extension of the elbow and forearm rotation were both improved to different extents, and all patients returned to their former work. According to the el- bow function diagnosis standard which is based on the Morrey et al,5 cases reached excellent level, 12 ca- ses reached good and 1 case was qualified,with a good rate of 94%. Conclusion It is very effective to use mini or absorbable screws to fix radial head fractures and ulnar coronoid fractures, to graft the free ten- don to reconstruct the lateral or medial collateral lig

关 键 词：肘关节 骨折 脱位 肌腱移植 微型可吸收螺钉 

分 类 号：R683.41[医药卫生—骨科学]