单一外侧切口治疗肘关节“三联征”  

Treatment of the terrible triad of the elbow using a single lateral incision （extensor digitorium communis split approach）

作　　者：查晔军[1] 蒋协远[1] 公茂琪[1] 王满宜[1] 

机构地区：[1]北京积水潭医院创伤骨科,100035

出　　处：《中华创伤骨科杂志》2014年第9期744-749,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 介绍经单一外侧切口（劈指总伸肌入路）治疗肘关节“三联征”的手术方法及效果. 方法 回顾性分析自2011年7月至2013年6月采用单一外侧切口治疗的23例肘关节“三联征”患者的临床资料,男14例,女9例;年龄16 ～ 68岁,平均42.1岁.冠状突骨折均采用经骨孔套索缝合前关节囊结合克氏针固定.桡骨头骨折：14例行HCS固定,9例行人工桡骨头假体置换.6例在肱骨外上髁钻孔后以2号爱惜邦线编织缝合对外侧副韧带复合体加伸肌总腱起点进行修复,17例采用缝合锚进行修复.20例患者采用Stryker DJDⅡ铰链式外固定支架固定以保护骨与软组织的修复. 结果 所有患者术后获6 ～ 30个月（平均19.0个月）随访.末次随访时所有患者的术后功能均能满足日常生活需要,无二期松解的患者,平均屈肘137.0°±8.8°,平均伸肘-4.8°±15.0°,平均屈伸活动范围为132.2°±21.5°;前臂平均旋前88.7°±6.3°,平均旋后89.6°±2.1°,平均旋转活动范围178.3°±6.5°;平均Mayo肘关节功能评分为（97.4±6.9）分.所有患者均未发生明显疼痛、不稳定、感染及神经损伤等并发症. 结论 肘关节“三联征”有明显骨性阻挡时采用单一外侧切口（劈指总伸肌入路）可获得良好的结果.若骨折较粉碎或固定后仍不稳定,可附加铰链式外固定支架保护.Objective To report the surgical techniques and results of treating the coronoid process and radial head fracture with dislocation of the elbow （terrible triad of the elbow） using a single lateral incision,the extensor digitorium communis （EDC） split approach.Methods A retrospective analysis was done of 23 patients with terrible triad of the elbow who had been treated by the authors from July 2011 to June 2013.They were 14 males and 9 females,with a mean age of 42.1 years （from 16 to 68 years）.All patients were treated via a single lateral approach.The coronoid process was fixated by Kirschner wires combined with the anterior capsule suture lasso fixation.For the radial head fracture,14 cases were fixated by AO HCS and 9 cases by Acumed radial head replacement.In repair of the lateral collateral ligament complex and the common extensor tendon,6 cases used No.2 Ethibon suture through bone holes at the humeral lateral epicondyle,and the other 17 cases used suture anchors.No medial collateral ligament was repaired.Twenty patients were fixated by Stryker DJD Ⅱ hinged external fixator to protect the bone and soft tissue.Results All patients were followed up from 6 to 30 months （mean,19.0 months）.The last follow-ups revealed that all patients recovered daily functions of the elbow with no need of secondary release.Their elbow flexion averaged 137.0° ± 8.8°,elbow extension-4.8° ± 15.0°,range of flexion and extension 132.2° ± 21.5°,forearm pronation 88.7° ± 6.3°,forearm supination 89.6° ± 2.1°,forearm rotation 178.3° ± 6.5°,and Mayo elbow performance score（MEPS） 97.4 ± 6.9 points.No obvious pain,instability,infection,or ulnar nerve symptoms was observed.Conclusions The elbow terrible triad with bone blocking can be treated by a simple lateral incision （the EDC split approach） to repair and fix the anterior capsule ＋ coronoid process fracture,radial head fracture,and the lateral collateral ligament complex and the common extensor tendon.If the elbow is still unstable,it is ad

关 键 词：肘关节 骨折 脱位 桡骨头 冠状突 

分 类 号：R687.3[医药卫生—骨科学]