游离桡骨头骨块重建冠状突联合人工桡骨头置换治疗复杂恐怖三联征的早期疗效  

Sh ort-term effectiveness of free radial head reco n stru ctio n of coronoid process combined with artificial radial head replacement in treatment of complex terrible triad of elbow

作　　者：陈涛[1,2] 马信龙 马剑雄[3] 余润泽[2] 喻德富 CHEN Tao;MA Xinlong;MA Jianxiong;YU Runze;YU Defu(Postgraduate Institute,Tianjin Medical University,Tianjin,300070,P.R.China;Department of Orthopaedics,Anhui No.2 Provincal People's Hospital,Hefei Anhui,230041,P.R.China;Institute of Orthopedics,Tianjin Hospital,Tianjin,300211,P.R.China)

机构地区：[1]天津医科大学研究生学院,天津300070 [2]安徽省第二人民医院骨科,合肥230041 [3]天津市天津医院骨科研究所,天津300211

出　　处：《中国修复重建外科杂志》2021年第2期139-143,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨使用游离桡骨头重建冠状突、人工桡骨头置换、尺骨鹰嘴内固定治疗复杂肘关节恐怖三联征的早期疗效。方法回顾分析2011年4月—2018年4月使用游离桡骨头重建冠状突、人工桡骨头置换、尺骨鹰嘴内固定治疗的12例复杂肘关节恐怖三联征患者临床资料。男8例,女4例;年龄26~62岁,平均44.5岁。致伤原因:交通事故伤5例,高处坠落伤7例。所有患者尺骨冠状突骨折Regan-Morrey分型均为Ⅲ型;桡骨头骨折Mason分型Ⅲ型7例,Ⅳ型5例。受伤至手术时间5~14 d,平均6.0 d。记录患者手术时间、术中出血量及并发症发生情况。术后复查肘关节X线片,观察骨折愈合情况,记录骨折愈合时间;测量并记录健、患侧肘关节屈伸及旋转活动度,根据Mayo肘关节功能评分评价肘关节功能。结果手术时间90~140 min,平均110 min;术中出血量100~300 mL,平均150 mL。患者术中均无血管损伤;1例出现尺神经支配区麻木,予以对症治疗1周后完全恢复。12例均获随访,随访时间12~22个月,平均16个月。末次随访时骨折均完全愈合,1例出现肘关节异位骨化,2例出现肘关节创伤性关节炎;均无内固定相关并发症发生。患肢屈肘、伸肘、旋前、旋后活动度与健侧比较差异均无统计学意义(P>0.05)。Mayo肘关节功能评分中位数为96分,四分位数间距为(94,97)分,优良率为91.7%。结论对于尺骨冠状突骨折Regan-MorreyⅢ型,桡骨头骨折MasonⅢ、Ⅳ型合并尺骨鹰嘴骨折的复杂肘关节恐怖三联征患者,使用游离桡骨头重建冠状突、人工桡骨头置换、尺骨鹰嘴内固定治疗,术后通过积极的康复功能锻炼,可取得较满意早期临床疗效。Objective To investigate the short-term effectiveness of free radial head reconstruction of coronoid process, artificial radial head replacement, and ulna olecranon internal fixation in the treatment of the complex terrible triad of the elbow. Methods Retrospective analysis was made on the clinical data of 12 patients with complex terrible triad of the elbow treated with free radial head reconstruction of coronoid process, artificial radial head replacement, and ulna olecranon internal fixation between April 2011 and April 2018. There were 8 males and 4 females with an average age of 44.5 years(range, 26-62 years). The causes of injury included 5 cases of traffic accident, 7 cases of falling from hight. The Regan-Morrey classification of ulnar coronoid process fractures was type Ⅲ;Mason classification of radial head fractures was type Ⅲ in 7 cases and type Ⅳ in 5 cases. The time from injury to operation was 5-14 days, with an average of 6.0 days.The operation time, intraoperative blood loss, and complications were recorded. After operation, X-ray film of elbow joint was reexamined, fracture healing condition was observed, and fracture healing time was recorded. The flexion, extension,and rotation of the elbow joints on the healthy and affected sides were recorded and measured. The elbow function was evaluated according to Mayo elbow function score. Results The operation time was 90-140 minutes(mean, 110 minutes);the intraoperative blood loss was 100-300 mL(mean, 150 mL). None of the patients had vascular injury during the operation. One patient developed numbness in the ulnar nerve innervation area and recovered completely after symptomatic treatment for 1 week. All the 12 patients were followed up 12-22 months, with an average of 16 months. At last follow-up, the fracture healed completely, 1 patient developed ectopic ossification of elbow joint, and 2 patients developed traumatic arthritis of elbow joint. No internal fixation-related complications occurred. There was no significant difference in the range

关 键 词：肘关节恐怖三联征 游离桡骨头骨块 冠状突重建 人工桡骨头置换 

分 类 号：R687.3[医药卫生—骨科学]