两种技术修复肘关节恐怖三联征中外侧副韧带复合体的疗效比较  

Comparison of two techniques for lateral collateral ligament complex repair in treatment of terrible triad of elbow

作　　者：景灵勇 赵华国[2] 刘观燚[2] JING Lingyong;ZHAO Huaguo;LIU Guanyi(Medicine School of Ningbo University,Ningbo Zhejiang,315211,P.R.China;Department of Orthopedics,Ningbo No.6 Hospital,Ningbo Zhejiang,315040,P.R.China)

机构地区：[1]宁波大学医学院,浙江宁波315211 [2]宁波市第六医院骨科,浙江宁波315040

出　　处：《中国修复重建外科杂志》2020年第12期1550-1554,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：2018年新世纪151人才工程培养基金;宁波市医学科技计划项目(2014A30);宁波市自然科学基金项目(2015A610216)。

摘　　要：目的比较穿骨隧道缝合固定和锚钉固定修复肘关节恐怖三联征中外侧副韧带复合体(lateral collateral ligament complex,LCLC)损伤的疗效。方法回顾分析2012年6月—2018年1月收治的50例肘关节恐怖三联征患者临床资料,其中22例采用锚钉固定(锚钉组)、28例采用穿骨隧道缝合固定(穿骨隧道组)修复LCLC。两组患者性别、年龄、骨折侧别、受伤至入院时间以及冠状突骨折、桡骨头骨折及肘关节恐怖三联征分型等一般资料比较,差异均无统计学意义(P>0.05)。记录并比较两组手术时间、术中出血量、骨折愈合时间以及并发症发生情况,末次随访时Mayo肘关节评分系统(MEPS)、关节活动度、Broberg-Morrey分级。结果两组患者均顺利完成手术,手术时间及术中出血量比较差异均无统计学意义(P>0.05)。患者均获随访,穿骨隧道组随访时间为(24.43±6.84)个月,锚钉组为(21.55±6.16)个月,差异无统计学意义(t=1.534,P=0.132)。X线片复查示,两组冠状突及桡骨头骨折均愈合,愈合时间组间比较差异无统计学意义(P>0.05)。末次随访时,两组肘关节屈伸活动度、旋转活动度、MEPS评分、Broberg-Morrey分级比较,差异均无统计学意义(P>0.05)。随访期间患者均无肘关节再脱位或不稳发生,穿骨隧道组并发症发生率为28.57%(8/28)、锚钉组为27.27%(6/22),差异无统计学意义(χ^2=2.403,P=0.121)。结论治疗肘关节恐怖三联征时,采用穿骨隧道固定或锚钉固定修复LCLC均可获得满意疗效。Objective To compare the effectiveness of transosseous tunnel fixation and drilling fixation for repair of lateral collateral ligament complex(LCLC)in treatment of terrible triad of elbow(TTE).Methods A clinical data of 50 patients with TTE between June 2012 and January 2018 were retrospectively analyzed.The LCLC was repaired with transosseous tunnel fixation in 22 patients(transosseous tunnel fixation group)and with drilling fixation in 28 patients(drilling fixation group).There was no significant difference between the two groups(P>0.05)in gender,age,fracture side,time from injury to admission,coronoid process fracture classification,radial head fracture classification,and TTE classification.The operation time,intraoperative blood loss,fracture healing time,and complications of the two groups were recorded.At last follow-up,the Mayo elbow performance system(MEPS)score,range of motion of elbow joint,and Broberg-Morrey classification were recorded.Results The operation of two groups were successfully completed.There was no significant difference in the operation time and intraoperative blood loss between the two group(P>0.05).The follow-up time was(24.43±6.84)months in the transosseous tunnel fixation group and(21.55±6.16)months in the drilling fixation group,and the difference was not significant(t=1.534,P=0.132).X-ray films showed that the coronoid process and radial head fractures in the two groups healed,and there was no significant difference in the healing time(P>0.05).At last follow-up,there was no significant difference in the flexion-extension activity,rotation activity,MEPS score,and Broberg-Morrey grading(P>0.05).During the follow-up,there was no re-dislocation or instability of the elbow joint.The incidence of complication was 28.57%(8/28)in the transosseous tunnel fixation group and 27.27%(6/22)in the drilling fixation group,showing no significant difference(χ^2=2.403,P=0.121).Conclusion Both transosseous tunnel fixation and drilling fixation can achieve good results in repair of LCLC for TTE.

关 键 词：肘关节恐怖三联征 外侧副韧带复合体 冠状突 桡骨头 

分 类 号：R687.4[医药卫生—骨科学]