外侧入路联合前内侧入路治疗肘关节损伤“复杂三联征”效果分析  

Analysis of the effect of lateral approach combined with anteromedial approach for the treatment of terrible triad of the elbow injuries

作　　者：田翔宇[1] 吴晗[1] 吴学建[1] 

机构地区：[1]郑州大学第一附属医院骨科三病区,河南郑州450052

出　　处：《河南医学研究》2017年第6期970-972,共3页Henan Medical Research

基　　金：国家自然科学基金(81472136)

摘　　要：目的分析采用外侧入路联合前内侧入路治疗肘关节损伤"复杂三联征"的临床效果。方法回顾性分析郑州大学第一附属医院骨科2011年9月至2015年7月采用外侧入路联合前内侧入路治疗并完整随访的27例肘关节损伤"复杂三联征"患者的临床资料。手术采用外侧入路联合前内侧入路逐次固定或置换桡骨头,修复外侧副韧带复合体,固定冠状突骨折部位,修复内侧副韧带前束,术后采用屈肘90°中立位支具辅助固定。采用Mayos肘关节评分(MEPS)评估患者术后肘关节功能。结果平均随访16个月(11~28个月)。末次随访时肘关节屈伸活动平均为121°(90°~140°),前臂旋转平均为136°(100°~150°),Moyas评分为70~100分,其中20例为优,5例为良,2例为中,优良率达93%。结论该入路治疗肘关节损伤"复杂三联征"可充分暴露术野,有效固定骨折,修复软组织损伤,恢复肘关节稳定性,术后患者可早期进行康复锻炼,防止关节强直。Objective To investigate the effect of lateral approach combined with anteromedial approach for the treatment of terrible triad of the elbow injuries. Methods Data of 27 patients with terrible triad of the elbow injuries treated in the First Affiliated Hospital of Zhengzhou University using this modified surgical technique from September of 2011 to July of 2015 were retrospectively analyzed. According to ulna coronoid fracture Regan-Morrey typing,there were 10 cases of typeⅠ,14 of type Ⅱ,and3 of type Ⅲ. According to Mason classification of radial head fracture,there were 5 cases of typeⅠ,18 of type Ⅱ,and 4 of typeⅢ. Surgical procedure included fixation or replacement of the radial head and repair of the ruptured lateral collateral ligament( LCL) through a lateral approach. Simultaneous fixation of the coronoid process and repair of medial collateral ligament( MCL)injury were performed through an anteromedial approach. After operation,13 cases were provided with elbow joint flexion 90° and plaster fixation at neutral position of fore arms. Mayo elbow performance score( MEPS) was determined for each patient at the latest clinic visit. Results The mean follow-up period was 16 months( range,11-28 months). At the latest follow-up,the mean flexion-extension arc of the elbow was 121°( range,90°-140°) and the mean forearm rotation was 136°( range,100°-150°). The mean MEPS was 91 points( range,70-100 points),with 20 excellent results,5 good results and 2 middle results.The excellent and good rate was 93%. Conclusion Lateral approach combined with anteromedial approach for terrible triad of the elbow can fully exposure the surgery field,and provid both bony and soft-tissue stability,thereby allowing early active motion as well as function recovery of the elbow.

关 键 词：肘关节损伤 骨折 固定 脱位 

分 类 号：R684[医药卫生—骨科学]