目的：回顾分析手术治疗肘关节“恐怖三联征”的疗效及策略。方法我院骨科从2010年7月至2013年10月手术治疗并完整随访的14例肘关节“恐怖三联征”患者,其中尺骨冠突骨折按照 Regan-Morrey 分型：Ⅰ型2例,Ⅱ型10例,Ⅲ型2例；桡骨头骨折按照 Mason 分型：Ⅰ型4例,Ⅱ型7例,Ⅲ型3例；本组病例中均合并有肘关节内、外侧副韧带的损伤。采取常规肘关节内、外侧联合入路,给予患肘关节复位,然后由深至浅依次固定冠状突骨折和桡骨头骨折,修复外侧副韧带。冠状突骨折采用微型钢板、拉力螺钉、缝合锚钉及套索缝合技术固定；桡骨头骨折采用克氏针、微型螺钉或微型钢板固定；所有患者给予编织非吸收性缝线缝合或锚钉修复外侧副韧带(lateral collateral ligaments,LCL),2例使用非吸收性编织缝线缝合、锚钉修复内侧副韧带(medical collateral ligaments,MCL),1例放置外侧铰链式外固定支架,余13例患者术后给予肘关节屈曲90°、前臂中立位石膏固定,术后积极进行康复功能锻炼。结果平均随访18个月(10~37个月)。所有病例实现骨折愈合,平均愈合时间为12.4周。术后6个月,肘关节屈位(0°~20°),伸位(130°~145°),平均活动范围为116.5°；旋前(60°~85°),旋后(45°~75°),平均旋转范围为126°。1例患者出现肘关节僵硬；2例患者术后6个月在影像学上出现异位骨化,但不影响肘关节功能。结论肘关节“恐怖三联征”通过积极有效的手术治疗,大多患者能够得到满意的结果。对于该类损伤,我们应尽可能通过有效的内固定重建骨及韧带的稳定结构,恢复肘关节的稳定性,及早配合正规的功能锻炼,最大程度恢复肘关节的功能。
目的：迴顧分析手術治療肘關節“恐怖三聯徵”的療效及策略。方法我院骨科從2010年7月至2013年10月手術治療併完整隨訪的14例肘關節“恐怖三聯徵”患者,其中呎骨冠突骨摺按照 Regan-Morrey 分型：Ⅰ型2例,Ⅱ型10例,Ⅲ型2例；橈骨頭骨摺按照 Mason 分型：Ⅰ型4例,Ⅱ型7例,Ⅲ型3例；本組病例中均閤併有肘關節內、外側副韌帶的損傷。採取常規肘關節內、外側聯閤入路,給予患肘關節複位,然後由深至淺依次固定冠狀突骨摺和橈骨頭骨摺,脩複外側副韌帶。冠狀突骨摺採用微型鋼闆、拉力螺釘、縫閤錨釘及套索縫閤技術固定；橈骨頭骨摺採用剋氏針、微型螺釘或微型鋼闆固定；所有患者給予編織非吸收性縫線縫閤或錨釘脩複外側副韌帶(lateral collateral ligaments,LCL),2例使用非吸收性編織縫線縫閤、錨釘脩複內側副韌帶(medical collateral ligaments,MCL),1例放置外側鉸鏈式外固定支架,餘13例患者術後給予肘關節屈麯90°、前臂中立位石膏固定,術後積極進行康複功能鍛煉。結果平均隨訪18箇月(10~37箇月)。所有病例實現骨摺愈閤,平均愈閤時間為12.4週。術後6箇月,肘關節屈位(0°~20°),伸位(130°~145°),平均活動範圍為116.5°；鏇前(60°~85°),鏇後(45°~75°),平均鏇轉範圍為126°。1例患者齣現肘關節僵硬；2例患者術後6箇月在影像學上齣現異位骨化,但不影響肘關節功能。結論肘關節“恐怖三聯徵”通過積極有效的手術治療,大多患者能夠得到滿意的結果。對于該類損傷,我們應儘可能通過有效的內固定重建骨及韌帶的穩定結構,恢複肘關節的穩定性,及早配閤正規的功能鍛煉,最大程度恢複肘關節的功能。
목적：회고분석수술치료주관절“공포삼련정”적료효급책략。방법아원골과종2010년7월지2013년10월수술치료병완정수방적14례주관절“공포삼련정”환자,기중척골관돌골절안조 Regan-Morrey 분형：Ⅰ형2례,Ⅱ형10례,Ⅲ형2례；뇨골두골절안조 Mason 분형：Ⅰ형4례,Ⅱ형7례,Ⅲ형3례；본조병례중균합병유주관절내、외측부인대적손상。채취상규주관절내、외측연합입로,급여환주관절복위,연후유심지천의차고정관상돌골절화뇨골두골절,수복외측부인대。관상돌골절채용미형강판、랍력라정、봉합묘정급투색봉합기술고정；뇨골두골절채용극씨침、미형라정혹미형강판고정；소유환자급여편직비흡수성봉선봉합혹묘정수복외측부인대(lateral collateral ligaments,LCL),2례사용비흡수성편직봉선봉합、묘정수복내측부인대(medical collateral ligaments,MCL),1례방치외측교련식외고정지가,여13례환자술후급여주관절굴곡90°、전비중립위석고고정,술후적겁진행강복공능단련。결과평균수방18개월(10~37개월)。소유병례실현골절유합,평균유합시간위12.4주。술후6개월,주관절굴위(0°~20°),신위(130°~145°),평균활동범위위116.5°；선전(60°~85°),선후(45°~75°),평균선전범위위126°。1례환자출현주관절강경；2례환자술후6개월재영상학상출현이위골화,단불영향주관절공능。결론주관절“공포삼련정”통과적겁유효적수술치료,대다환자능구득도만의적결과。대우해류손상,아문응진가능통과유효적내고정중건골급인대적은정결구,회복주관절적은정성,급조배합정규적공능단련,최대정도회복주관절적공능。
Background Elbow joint"terrible triad"refers to posterior dislocation of elbow joint combined with ulna coracoid process fracture and radius head fracture,often accompanied with injuries of medial collateral ligament and/or lateral collateral ligament of elbow joint.Distal clavicular fracture combined with coracoclavicular ligament rupture frequently behave as unstable fracture,with the opportunity for fracture non-union in conservative therapy being as high as 21%.During the period from July 2010 to October 2013,our department performed operative treatment for 14 cases of elbow joint"terrible triad" with complete follow-up,and achieved satisfactory therapeutic effects.The specific process is hereby reported as follows.Method I.General materials:This group includes 14 cases (1 1 male cases and 3 female cases),aged 23-48 years,with an average age of 35.4 years;5 cases in the left side,9 cases in the right side,all suffer from closed injury.No one case suffers from related neurovascular injury.Injury causes:High falling accident 5 cases,traffic accident 3 cases, falling injury 4 cases and sport injury 2 cases.After hospital admission,according to the routine procedure,we performed elbow joint X-ray anterioposterior and lateral film,elbow joint CT scanning and three-dimensional reconstruction to judge the type of fracture and the fracture displacement condition.Ulna coronoid fracture Regan-Morrey typing ,10 cases of type Ⅲ,and 2 cases of type Ⅲ;According to Mason typing of radius head fracture,7 cases of type Ⅲ,and 3 cases of type Ⅲ,of which 1 case is combined with ipsilateral distal radius fracture,And 1 case is combined with ipsilateral ulnar fracture;All the cases in this group are combined with injuries of medial collateral ligament and/or lateral collateral ligament of elbow joint.Ⅱ.Operative method:Allow the patient to lie flat on operating table,and place inflatable tourniquets on the proximal ends of affected limbs. Under brachial plexus block anesthesia, conventionally use elbow joint medial and lateral combined approaches,perform reduction of affected elbow joint,then in the sequence from the shallower to the deeper repair the ulna coracoid process fracture,the anterior joint capsule,the radius head fracture, the lateral collateral ligament and the starting point of common extensor tendon.The ulna coracoid process fracture is fixed by using mini-plate,lag screw,stitching anchor or rope stitching technique;radial head fracture is fixed by using kirschner wire,mini-screw and mini-plate;For all the cases,we use non-absorbable braided suture or anchor to repair their lateral collateral ligaments (LCL).Prior to incision closure,perform varus-valgus rotation test on straight position of elbow joint and cubitus valgus overload test to judge the recovery of elbow joint stability.In the process of passive flexion of elbow joint,3 cases show poor concentric circle stability,for 2 cases of them,we use non-absorbable braided suture and anchor to repair their medial collateral ligaments (MCL);For 1 case,place lateral articulated type external fixation support, and keep elbow joint flexion 90°fixed hinge during operation;the other 12 cases can still maintain stability.After operation,13 cases are provided with elbow joint flexion 90°and plaster fixation at neutral position of fore arms.Ⅲ.Functional exercise and follow-up:13 cases in plaster fixation perform finger movement as well as Biceps brachii muscle/Triceps brachii muscle isometric contraction training;At postoperative 48h,start passive elbow joint flexion and extension activity as well as fore arm rotation activity.At operative 1-2 week,1 case assisted with external fixation started functional exercise;in the 1st week post operation,adjust the knob at the center of hinge support,instruct the affected elbows to perform flexion and extension function exercise;At post-operative 6 th-8 th week,remove external fixation support.In the process of rehabilitation,avoid hyperextension of elbow joint.After operation,respectively in the follow-up on the 1 st day, at the 2 nd week, 1 st month, 3 rd month, 6 th month and 12 th month, take X-ray anterioposterior and lateral film of affected elbow joints.Observe the healing condition of fracture fragments as well a s the occurrence of postoperative complications such as heterotopic ossification and Osteoarthritis;Investigate the improvements in elbow joint function,and instruct the patients to perform functional exercise.Upon completion of follow-up,perform evaluation of therapeutic effect according to Mayo elbow joint function scoring standard.Results 14 cases in this group obtained follow-up,with an average follow-up time of 18 months (10-37 months).The clinical fracture union time is postoperative 10-1 5 weeks,with an average time of 12.4 weeks.In postoperative 6 months, elbow joint flexion position (0°-20°),extension position (130°-145 °),with an average range of joint motion being 1 1 6.5°;pronation (60°-85°)supination (45°-75°),with an average rotation range of 126°.1 case has stiff elbow joint;2 cases show heterotopic ossification in imageological examination at the 6 th month after operation,which,however do not affect the functions of elbow joint.Evaluation according to Mayo scoring standard:Excellent 6 case,good 4 cases,general 2 cases and poor 1 case. Conclusion Through active and effective operative treatment for elbow joint"terrible triad",most of the patients can obtain satisfactory results.For such type of injuries,we should make every effort to reconstruct stable structure of bone and ligament through effective internal fixation and recover the stability of elbow joint in combination with timely and normal functional exercise,so as to recover the functions of elbow joint to the maximum extent.
