肘关节三联征治疗方案的深入讨论  

In-depth discussion on the treatment of terrible triad of the elbow

作　　者：李宁鑫 杨朝晖[1] Li Ningxin;Yang Zhaohui(Department of Orthopedics,Second Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China)

机构地区：[1]山西医科大学第二医院骨科

出　　处：《中国组织工程研究》2020年第15期2453-2460,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:近年来肘关节三联征损伤的诊断和治疗方面取得了迅速进展。目的:简单介绍肘关节三联征的定义、相关基本解剖及稳定结构、损伤机制、分型,深入探讨其治疗方案。方法:第一作者检索PubMed、CNKI及万方数据库建库至2019年9月的文献,以“terrible triad of the elbow,elbow joint,Fracture dislocation”为英文检索词,以“肘关节恐怖三联征,肘关节骨折脱位”为中文检索词,查阅大量近年肘关节三联征的相关文献,全面分析并总结其治疗策略。结果与结论:对于肘关节三联征损伤患者,术前必须仔细检查,认真分析影像学检查结果及打印3D模型,准确判断肘部骨性结构和韧带损伤程度;术中通常先通过单独外侧入路或内外联合入路重建桡骨头的稳定性、修复冠突骨折及外侧韧带复合体损伤后,然后行肘关节稳定性检测,以决定是否需要进一步修复内侧韧带复合体或应用铰链式外固定器来恢复肘关节的稳定性;术后积极行早期康复功能锻。通过上述系统治疗可相对减少术后并发症,加速骨折愈合,改善肘关节功能和患者生活质量。BACKGROUND:The diagnosis and treatment of the terrible triad of the elbow have achieved a breakthrough.OBJECTIVE:To introduce the definition,basic anatomy,stable structure,injury mechanism and classification of terrible triad of the elbow,and to discuss the treatment plan deeply.METHODS:The first author searched PubMed,CNKI and Wanfang databases for the articles published before September 2019.The keywords were“terrible triad of the elbow,elbow joint,fracture dislocation”in English and Chinese,respectively.A large number of articles concerning the terrible triad of the elbow in recent years were reviewed,and the treatment strategy was summarized.RESULTS AND CONCLUSION:For the terrible triad of the elbow,the operator must carefully check the patient before operation,carefully analyze the imaging examination results and three-dimensional printed model,and accurately judge the bone structure of the elbow and degree of ligament injury.During the operation,the stability of the radial head,the fracture of the coronoid process and the injury of the lateral ligament complex are usually reconstructed through a single lateral approach or a combination of internal and external approaches.Then,the stability of elbow joint is tested to determine whether it is necessary to repair the medial ligament complex or use the hinged external fixator to restore the stability of elbow joint.Early active rehabilitation is needed.The above systematic treatment can reduce postoperative complications,accelerate fracture healing,and improve elbow joint function and patients’quality of life.

关 键 词：肘关节三联征 肘关节恐怖三联征 肘关节 骨折脱位 后外侧旋转不稳定 治疗方案 受伤机制 复杂肘关节不稳 

分 类 号：R459.9[医药卫生—治疗学] R363.21[医药卫生—临床医学]