肘关节“恐怖三联征”合并肱骨远端骨折的手术治疗  

Surgical treatment of terrible triad of the elbow combined with distal humeral fracture

作　　者：吴加东[1] 卞化 沈孝天 王超[1] 孙焕建[1] 王友华[2] 刘璠[2] Wu Jiadong;Bian Hua;Shen Xiaotian;Wang Chao;Sun Huanjian;Wang Youhua;Liu Pan(Department of Orthopaedics,The Affiliated Yancheng Hospital of Southeast University Medical College,Yancheng 224005,China;Department of Orthopaedics,The Affiliated Hospital of Nantong University,Nantong 226001,China)

机构地区：[1]东南大学医学院附属盐城医院(盐城市第三人民医院)骨科,224005 [2]南通大学附属医院骨科,226001

出　　处：《中华肩肘外科电子杂志》2017年第3期194-198,共5页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：盐城市医学科技发展计划项目(YK2013068)

摘　　要：目的探讨手术治疗肘关节"恐怖三联征"合并肱骨远端骨折的临床疗效。方法选择东南大学医学院附属盐城医院2005年1月至2014年6月收治的13例肘关节"恐怖三联征"合并肱骨远端骨折患者,男8例,女5例,年龄24~56岁,平均(31.4±2.1)岁,肱骨远端骨折AO分型:B1型3例,C1型7例,C2型3例。肱骨远端骨折行钢板固定,桡骨头骨折行钢板、螺钉固定或置换,冠突骨折行钢板、螺钉或克氏针固定,修复内外侧副韧带。术后按照Broberg-Morrey评估系统对肘关节功能进行评分。结果 11例患者获得随访,随访时间12~22个月,平均(16.2±2.1)个月。骨折愈合时间19~23周,平均(20.2±3.2)周。Broberg-Morrey评分:优2例(18.2%)、良6例(54.5%)、可2例(18.2%)、差1例(9.1%),优良率72.7%。肘关节屈伸范围75~116°,平均(101.2±10.9)°;前臂旋转范围为90~120°,平均(107.7±8.4)°。结论肘关节"恐怖三联征"合并肱骨远端骨折为高能量损伤,关节严重不稳定,需重建骨关节及软组织的解剖结构,肘关节功能可得到良好恢复。Background With the rapid development of industry and transportation,the occurrence of complex elbow fractures and dislocations is increasing by years,to which people have paid more attention on.In 1996,the posterior elbow dislocation combined with radial head and coronoid process fractures was named as“terrible triad of elbow”by Hotchkiss.It is combined with distal humeral fractures,secondary to the great violence perpendicular to the long axis in elbow extension and the direct impact of distal humerus and proximal ulna.Due to the anatomical features of medial and lateral collateral ligaments attach points,it is often associated with distal humeral fragment.Therefore,compared with simple“terrible triad”,bone structure damage is often more severe in this type of injury.Methord(1)General information.From January 2005 to June 2014,13 cases(8 males and 5 females)with terror triad of elbow combined with distal humerus fractures were treated,all of which were closed injuries,including 2 cases of ulnar nerve injuries.The ages were 24-56 years with an average of(31.4±2.1)years.Causes of injuries included 7 cases of traffic injuries(53.8%),4 cases of falling injuries(30.8%)and 2 cases of other injuries(15.4%).AO classification of distal humeral fractures:3 cases of type B1,7 cases of type C1 and 3 cases of type C2.

关 键 词：肘关节 恐怖三联征 肱骨远端骨折 

分 类 号：R687.3[医药卫生—骨科学]