肘关节“恐怖三联征”伴尺骨近端粉碎性骨折的手术治疗  

Surgery treatment for terrible triad of elbowassociated with ulnar proximal comminuted fracture

作　　者：赵王林[1] 李智奎[1] 包可[1] 唐镇江[1] 毕衡[1] 顾海潮[1] 黄信源[1] 向俊宜[1] 

机构地区：[1]云南省中医医院骨科,昆明650021

出　　处：《中国骨与关节外科》2016年第1期62-68,共7页Chinese Journal of Bone and Joint Surgery

摘　　要：背景：以往肘关节后脱位伴桡骨头及尺骨冠状突骨折（肘关节“恐怖三联征”）的手术治疗方法需要长期制动，常导致肘关节复发性不稳定、肘关节僵硬等并发症，导致肘关节严重功能障碍。目的：探讨切开复位内固定治疗肘关节“恐怖三联征”伴尺骨近端粉碎性骨折的方法与效果。方法：2011年7月至2014年7月，云南省中医医院收治肘关节“恐怖三联征”伴尺骨近端粉碎性骨折患者8例，男6例，女2例；年龄32-65岁，平均（34.5±8.6）岁。桡骨头骨折按John-ston-Mason分型均为Ⅳ型。冠突骨折按Regan-Morrey分型：Ⅰ型2例；Ⅱ型5例；Ⅲ型1例。8例均采取肘关节后侧入路切开复位内固定治疗，冠突、尺骨近端骨折行内固定；桡骨头骨折行内固定、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。随访记录病情主诉、肘关节屈伸活动度、前臂旋转活动度、关节稳定性、X线片情况，采用MEPS评分评估肘关节功能。结果：8例患者均获得随访，随访时间为6-36个月，平均（19.9±2.1）个月。骨折全部愈合，愈合时间为11-17周，平均（15.4±1.4）周。在末次随访时患侧肘关节均无明显疼痛及不稳，无浅表及深部组织感染发生，1例患者肘前出现少量异位骨化，不影响关节活动。末次随访时肘关节平均屈伸范围为124.32°±13.66°（76°-135°）；前臂平均旋转范围为136.64°±16.47°（80°-150°）。肘关节MEPS评分68-94分，平均（88.34±5.20）分，优3例，良4例，可1例，差0例，优良率为87.5%。结论：肘关节“恐怖三联征”合并尺骨近端粉碎性骨折为高能量损伤，关节严重不稳定，应尽可能采取手术治疗，以重建肘关节及软组织的解剖结构、恢复关节稳定性。Background： Prolonged immobilization usually is essential in the treatment of elbow dislocations associated with radial head and coronoid fractures （also named by the terrible triad of the elbow）. However, recurrent instability, stiff-ness, severe dysfunction of the elbow and other complications may result from long-term immobilization. Objective：To ex-plore the technique and curative effectiveness of open reduction and internal fixation for the terrible triad of the elbow com-bined with ulnar proximal comminuted fractures. Methods：Eight patients with the terrible triad of the elbow and ulnar proxi-mal comminuted fracture underwent internal fixation and metal prosthesis replacement by posterior incision in our hospital between July 2011 and July 2014. There were 6 men and 2 women with a mean age of （34.5 ± 8.6） years （range, 32-65 years）. The radial head fracture was typeⅣaccording to Johnston-Mason classification in all the patients. Coronoid fracture was typeⅠin 2, typeⅡin 5 and typeⅢin 1 according to Regan-Morrey classification. The medial and lateral collateral lig-aments were repaired. A plaster was applied for 3 weeks after operation in position with elbow flexion at 90° and forearm ro-tation in neutral. The complaint of illness, elbow range of motion, forearm rotating activity, joint stability and radiographs were recorded during follow-up. Mayo Elbow Performance Score （MEPS） was used to evaluate the function of the elbow. Results：The eight patients were followed up for （19.9±2.1） months on average （range, 6-36 months）. All the fractures were healed, and the mean duration of healing was （15.4 ± 1.4） weeks （range, 11-17 weeks）. No severe pain or instability of in-jured elbows, superficial or deep tissue infections occurred at the last follow-up. A small amount of ossification was found in anterior cubital soft tissue of one patient, but it did not affect the joint motion. At the last follow-up, the range of elbow flexion-extension was 124.32°± 13.66° �

关 键 词：肘关节 桡骨骨折 尺骨骨折 脱位 骨折固定术 

分 类 号：R687.3[医药卫生—骨科学]