肘关节“恐怖三联征”的手术治疗及疗效分析  

Clinic Effect of Surgical Intervention for Terrible Triad of the Elbow

作　　者：周祥吉[1] 薛丁山 杨富强[1] 葛健健 范启申[1] 

机构地区：[1]山东省潍坊市解放军第89医院全军创伤骨科研究所,山东261021

出　　处：《中国现代手术学杂志》2014年第2期122-125,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨手术治疗肘关节“恐怖三联征”的要点，分析影响临床疗效的因素。方法回顾性分析2010年6月-2013年1月收治的11例肘关节“恐怖三联征”患者的临床资料，均行手术治疗：肘外侧入路修复桡骨小头骨折和肘外侧副韧带，肘前内侧或肘内侧入路修复冠突、前侧关节囊及内侧副韧带，恢复肘关节同心圆稳定性。早期进行针对性康复训练。结果本组术中出血平均250（200—600）ml，手术时间平均2（1～2．5）h。本组11例均获随访，平均随访7．5（4～26）个月。肘关节活动度屈曲平均125°±30°，伸展25°±15°，前臂旋转120°±35°。无感染和皮肤坏死，无骨不愈合病例，4例发生骨化性肌炎。按Mayo肘关节功能评分：优4例，良5例，可2例。结论肘关节“恐怖三联征”手术治疗选择肘外侧入路联合肘前内侧或肘内侧入路可以获得良好的手术显露；骨支持结构特别是冠状突的解剖复位是手术成功关键因素，也是软组织得以良好修复的前提；早期合理的康复方案是保证手术疗效的重要环节。Objective To investigate the key points on surgical procedure of the treatment of elbow terrible triad, and to explore the impact factors of the clinic outcome. Methods The clinical data of 11 cases with the elbow terrible triad admitted from June 2010 to January 2013 was analyzed retrospectively. All cases were treated by surgical intervention： The radial head fracture and the lateral collateral ligament were repaired via the approach of lateral incision of elbow, similarly the coronoid process of ulna, anterior joint capsule and medial collateral ligament were repaired through medial or anteromedial incision, the stability of concentric anatomical of elbow joint was recovered. Rehabilitation training was carried out in early stage after the operation. Results The intra-operative blood loss was 200 to 600 ml with an average of 250 ml, and the operative duration was 1 to 2.5 hours with an average of 2 hours. All cases were followed up for 4 to 26 months（ mean 7.5 months）. The mean flexion-extension range of elbow was 125°±30°, while the mean pronation-supination range of forearm was 120°±35°. No necrosis of skin, infection or disunion occurred. Myositis ossifieans emerged in 4 cases. The result was achieved excellent in 4 cases, good in 5 cases and fair in 2 cases according to Mayo elbow scale. Conclusions The surgery of terrible triad of the elbow can be achieved ideal operating field by united the lateral incision with the medial or anteromedial incision of elbow ; The anatomical reduction of bone supporting structure especially the coronoid process is the key factor to ensure success of the surgery, and is the premise of soft tissues repairing; The rational rehabilitation program is the important procedure to ensure the surgical effect.

关 键 词：肘关节“恐怖三联征” 尺骨冠状突 桡骨头骨折 康复 

分 类 号：R687.3[医药卫生—骨科学]