肘前入路钢板内固定联合Kocher入路桡骨头置换治疗肘关节恐怖三联征  

Anterior elbow approach plate fixation combined with Kocher approach humeral head replacement for treatment of terrible triad of the elbow injuries

作　　者：王庆伟 王华松[2] 黄继锋[2] 丰瑞兵 庞炯宇 杨晨曦 Wang Qingwei;Wang Huasong;Huang Jifeng(Department of Orthopedics,JingmenNo.1People's Hospital,Jingmen Hubei,448000;Wuhan General Hospital of Chinese People's Liberation Army,Wuhan Hubei,430070,China)

机构地区：[1]荆门市第一人民医院骨科,湖北荆门448000 [2]中国人民解放军武汉总医院骨科,湖北武汉430070

出　　处：《生物骨科材料与临床研究》2018年第6期15-17,21,共4页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨采用肘关节前方入路微型钢板内固定联合外侧Kocher入路桡骨头置换治疗肘关节恐怖三联征的临床疗效。方法回顾性分析从2015年6月至2017年6月我科收治和采用肘关节前方入路微型钢板内固定联合外侧Kocher入路桡骨头置换治疗肘关节恐怖三联征的8例病例资料。其中男7例,女1例;年龄20～47岁,平均28.3岁;患者均为单侧损伤,右侧损伤5例,左侧3例。尺骨冠状突骨折按Regan-Morrey分型:Ⅰ型1例,Ⅱ型5例,Ⅲ型2例;桡骨头骨折按Mason分型:Ⅲ型5例,Ⅳ型3例。均采用肘关节前方入路微型钢板内固定联合外侧Kocher入路桡骨头置换治疗,记录手术时间、术中出血量,观察切口愈合、骨折愈合情况及术后并发症情况,应用Mayo肘关节功能评分标准(MEPS)评定肘关节功能。结果本组获随访10～23个月,平均15.7个月,所有8例患者切口均一期愈合,骨折均获得临床愈合。未见神经、血管损伤及肘关节骨化性肌炎等并发症。根据患者肘关节的运动功能、稳定性、疼痛和日常活动等情况采用Mayo肘关节功能评分标准(MEPS)评估手术疗效:优3例,良4例,中1例,优良率87.5%。结论采用肘关节前方入路微型钢板内固定联合外侧Kocher入路桡骨头置换治疗肘关节恐怖三联征,具有术中显露充分、固定可靠及手术时间短等优势,临床疗效满意。Objective To explore the clinical efficacy of using the anterior approach of the elbow to fix the terrible triad of the elbow with miniature steel plate internal fixation and Kocher approach humeral head replacement. Methods A retrospective analysis of 8 cases of patients with elbow trigeminal terpenoids treated in our department from Jun 2015 to Jun2017 in our department and using the elbow anterior approach miniature plate internal fixation combined with lateral Kocher approach humeral head replacement. Male 7 cases, female 1 case; aged 20 to 47 years old, average 28.3 years old. All patients were unilateral lesions, with 5 right lesions and 3 left lesions. According to the Regan-Morrey classification, ulnar coronoid process fractures were classified as type Ⅰ 1, type Ⅱ 5 and type Ⅲ 2. According to the Mason classification, radial head fractures were classified as type Ⅲ in 5 cases and type Ⅳ in 3 cases. All patients were treated with anterior elbow approach microplate fixation combined with lateral Kocher approach humeral head replacement. The operative time and blood loss were recorded. The incision healing, fracture healing and postoperative complications were observed. Mayo elbow function score was used the standard(MEPS) assesses elbow joint function. Results The group was followed up for 10 to 23 months, an average of 15.7 months, all 8 cases of incision healed in a primary,fractures were clinically healed. No complications such as nerve, blood vessel injury, and myosinous myositis were observed. According to motor function, stability, pain and daily activities of the elbow, the Mayo Elbow Functional Rating Scale(MEPS) was used to evaluate the surgical outcome: excellent in 3 cases, good in 4 cases and moderate in 1 case.The excellent and good rate was 87.5%. Conclusion The use of anterior elbow approach miniature plate internal fixation and lateral Kocher approach humeral head replacement for the treatment of elbow terrible triads, With advantages such as full exposure, reliable fixation and sh

关 键 词：肘关节 恐怖三联征 骨折 脱位 手术入路 

分 类 号：R681.7[医药卫生—骨科学]