CAJ | 학술논문

目的探讨采用外侧入路联合前内侧入路治疗肘关节“恐怖三联征”的手术疗效.方法回顾性分析2008年7月至2011年1月,采用外侧入路联合前内侧入路治疗23例肘关节“恐怖三联征”患者,其中21例获得完整随访资料,男17例,女4例;年龄17～ 63岁,平均38.4岁;坠落伤15例,运动损伤4例,交通伤2例;受伤至手术时间为2～8d,平均4d.尺骨冠突骨折O' Driscoll分型:A1型5例,A2型12例,B2型4例;桡骨头骨折Mason分型:Ⅰ型2例,Ⅱ型12例,Ⅲ型7例;软组织损伤仲飙等分型:Ⅰ型6例,Ⅱ型12例,Ⅲ型3例.先采用Kocher入路内固定或人工桡骨小头置换治疗桡骨小头骨折,暂时修补外侧副韧带复合体,而后通过前内侧入路固定冠突骨折并修补内侧副韧带损伤;术后采用铰链式外固定支具辅助固定.术后分别采用Mayo肘关节评分(Mayo elbow performence score,MEPS)和Broberg-Morrey分级评估患者肘关节功能及创伤性关节炎程度.结果 21例患者均获得随访,随访时间24～ 48个月,平均32个月.末次随访时,患者肘关节屈伸及前臂旋转平均活动度分别为126°(范围,115°～135°)和139°(范围,125°～145°);MEPS评分为85～ 100分,平均95分,其中19例评定为优,2例为良,优良率为100％,无一例发生肘关节复发不稳定.术后1周,1例发生伤口浅表感染,经清创及静脉使用抗生素治疗后愈合;术后3个月,发生异位骨化症2例,桡骨头骨折骨不连1例,尺神经麻痹1例,均未行手术处理.结论采用外侧入路联合前内侧入路治肘关节“恐怖三联征”具有一期同时重建骨结构和恢复软组织稳定性的优势,术后患者能早期进行功能锻炼,利于肘关节功能恢复.
목적 탐토채용외측입로연합전내측입로치료주관절“공포삼련정”적수술료효.방법 회고성분석2008년7월지2011년1월,채용외측입로연합전내측입로치료23례주관절“공포삼련정”환자,기중21례획득완정수방자료,남17례,녀4례;년령17～ 63세,평균38.4세;추락상15례,운동손상4례,교통상2례;수상지수술시간위2～8d,평균4d.척골관돌골절O' Driscoll분형:A1형5례,A2형12례,B2형4례;뇨골두골절Mason분형:Ⅰ형2례,Ⅱ형12례,Ⅲ형7례;연조직손상중표등분형:Ⅰ형6례,Ⅱ형12례,Ⅲ형3례.선채용Kocher입로내고정혹인공뇨골소두치환치료뇨골소두골절,잠시수보외측부인대복합체,이후통과전내측입로고정관돌골절병수보내측부인대손상;술후채용교련식외고정지구보조고정.술후분별채용Mayo주관절평분(Mayo elbow performence score,MEPS)화Broberg-Morrey분급평고환자주관절공능급창상성관절염정도.결과 21례환자균획득수방,수방시간24～ 48개월,평균32개월.말차수방시,환자주관절굴신급전비선전평균활동도분별위126°(범위,115°～135°)화139°(범위,125°～145°);MEPS평분위85～ 100분,평균95분,기중19례평정위우,2례위량,우량솔위100％,무일례발생주관절복발불은정.술후1주,1례발생상구천표감염,경청창급정맥사용항생소치료후유합;술후3개월,발생이위골화증2례,뇨골두골절골불련1례,척신경마비1례,균미행수술처리.결론 채용외측입로연합전내측입로치주관절“공포삼련정”구유일기동시중건골결구화회복연조직은정성적우세,술후환자능조기진행공능단련,리우주관절공능회복.
Objective To investigate the outcomes of lateral approach combined with anteromedial approach for the treatment of terrible triad of the elbow injuries.Methods Data of 23 patients with terrible triad of the elbow injuries treated at our hospital using this modified surgical technique from July 2008 to January 2011 were retrospectively analyzed.Two patients lost to follow-up leaving 21 patients (21 elbows) for evaluation.There were 17 males and 4 females with a mean age of 38.4 years (range,17-63 years).The 21 elbows were treated surgically after a mean of 4 days from the injury.According to O'Driscoll classification of coronoid fractures,there were 5 cases of type A1,12 of A2,and 4 of B2.According to Mason classification of radial head fracture,there were 2 cases of type Ⅰ,12 of Ⅱ,and 7 of Ⅲ.According to Zhong Biao classification of soft tissue injury in terrible triad of the elbow,there were 6 cases of type Ⅰ,12 of Ⅱ,and 3 of Ⅲ.Our surgical procedure included fixation or replacement of the radial head and repair of the ruptured lateral collateral ligament (LCL) through a lateral approach.Simultaneous fixation of the coronoid process and repair of the common flexor muscle and medial collateral ligament (MCL) injury were performed through an anteromedial approach.Mayo elbow performance score (MEPS) was determined for each patient at the latest clinic visit.The Broberg and Morrey classification was used for evaluating traumatic arthritis.Results The mean follow-up period was 32 months.At the latest follow-up the mean flexion-extension arc of the elbow was 126° (range,115°-135°) and the mean forearm rotation was 139°(range,125°-145°).The mean MEPS was 95 points (range,85-100 points),with 19 excellent results and 2 good results.Concentric stability was restored in all cases.Early post-operative complication occurred in one patient as a wound infection,which healed uneventfully after surgical debridement and antibiotic therapy.Late post-operative complication occurred in four patients including two cases of heterotopic ossification,1 case of radial head nonunion,and one case of ulnar nerve neuropathy,but none of them required additional surgery.Conclusion Lateral approach combined with anteromedial approach for terrible triad of the elbow provided both bony and soft-tissue stability,thereby allowing early active motion as well as functional recovery of the elbow.