CAJ | 학술논문

目的探讨手术治疗肘关节后脱位合并桡骨头和尺骨冠状突骨折("恐怖三联征")的临床疗效.方法 2004年1月至2009年3月收治9例肘关节"恐怖三联征"患者.桡骨头骨折根据Schatzker-Tile分型,Ⅰ型4例,Ⅱ型3例,Ⅲ型2例.尺骨冠状突骨折按Rogan-Morrey法分型,Ⅰ型2例,Ⅱ型5例,Ⅲ型2例.手术方式采用由深至浅的层次修复,依次为冠状突骨折,前关节囊,桡骨头骨折,外侧关节囊和伸肌总腱附着点.如存在外翻不稳定,需要修复内侧副韧带.术后肘关节完全旋前位屈曲90°固定7-10 d,6周以内避免进行完全伸直旋后位功能锻炼.8周可以进行肌力锻炼,3个月左右可以恢复日常生活.结果所有患者均得到随访,随访时间6～60(31±6)个月.术后3个月,9例患者的屈伸度为80°～110°(102°±3°);前臂旋转幅度100°～150°(135°±6°).根据Mayo评分标准,优5例,良3例,可1例.术后6个月发现3例出现异位骨化,2例不影响功能未进行处置,1例影响屈伸功能,给予外侧入路切除骨化块,术后早期功能锻炼,Mayo评分由可升至良.结论肘关节"恐怖三联征"的治疗关键是恢复正常的肱桡、肱尺关节解剖关系,修复损伤的韧带及关节囊,保证肘关节的稳定形成.如果软组织损伤严重可以采用铰链式外固定架固定促进软组织的修复,同时并不影响肘关节的早期功能锻炼,避免肘关节僵硬.
목적 탐토수술치료주관절후탈위합병뇨골두화척골관상돌골절("공포삼련정")적림상료효.방법 2004년1월지2009년3월수치9례주관절"공포삼련정"환자.뇨골두골절근거Schatzker-Tile분형,Ⅰ형4례,Ⅱ형3례,Ⅲ형2례.척골관상돌골절안Rogan-Morrey법분형,Ⅰ형2례,Ⅱ형5례,Ⅲ형2례.수술방식채용유심지천적층차수복,의차위관상돌골절,전관절낭,뇨골두골절,외측관절낭화신기총건부착점.여존재외번불은정,수요수복내측부인대.술후주관절완전선전위굴곡90°고정7-10 d,6주이내피면진행완전신직선후위공능단련.8주가이진행기력단련,3개월좌우가이회복일상생활.결과 소유환자균득도수방,수방시간6～60(31±6)개월.술후3개월,9례환자적굴신도위80°～110°(102°±3°);전비선전폭도100°～150°(135°±6°).근거Mayo평분표준,우5례,량3례,가1례.술후6개월발현3례출현이위골화,2례불영향공능미진행처치,1례영향굴신공능,급여외측입로절제골화괴,술후조기공능단련,Mayo평분유가승지량.결론 주관절"공포삼련정"적치료관건시회복정상적굉뇨、굉척관절해부관계,수복손상적인대급관절낭,보증주관절적은정형성.여과연조직손상엄중가이채용교련식외고정가고정촉진연조직적수복,동시병불영향주관절적조기공능단련,피면주관절강경.
Objective To analyze and evaluate the effect of the elbow posterior dislocation with radial head and coronoid fractures (the terrible triad of the elbow). Methods Nine patients of the terrible triad of the elbow were treated from January 2004 to March 2009. Among of them, according to Schatzker-Tile classification, the radial head fractures were 4 in type I , 3 in type II , 2 in type Ⅲ. According to Rogan-Morrey classification, the ulnar coronoid fractures were 2 in type I , 5 in type II , 2 in type Ⅲ. The general approach was to repair the damaged structures sequentially from deep to superficial, from coronoid to anterior capsule to radial head to lateral ligament complex to common extensor origin. If there was valgus instability in the elbow after the operation, repaired medial ligament with nonabsorption suture. Plaster was applied for 7-10 days,in position of with elbow flexion in 90° and the forearm in full pronation. Unrestricted morion was then begun, and strengthening was initiated at 8 weeks. Returned to regular occupation depended on the degree of physical activity required, and it typically taken 3 months for heavy physical laborers to return to work. , Results All patients were followed up for 6-60 (31 ± 6) months. Three months postoperatively, the flexion-extension arc of the elbow was 80° -110° (102° ± 3° ), and the pronation-supination arc of the forearm was 100° -150° (135° ±6°) respectively. According to the criteria of the Mayo score, the results were excellent in 5 cases, good in 3 cases, and fair in 1 case. Three cases were heterotopic ossification 6 months postoperatively, 2 cases of them didn't impact the elbow function, didn't treat, 1 case impact the flexion-extension of the elbow, cut the heterotopic ossification from the lateral approach, Mayo score improved from fair to good. Conclusion The key points for treating the terrible triad of the elbow are recovering the elbow normal anatomy and starting early functional exercises in order to avoid the elbow stiff.