摘要
目的总结肱尺关节后脱位合并桡骨头和尺骨冠状突骨折的手术治疗体会。方法回顾5例典型肘关节"恐怖三联征"的手术治疗结果。手术方法包括:经肘关节外侧入路予桡骨头骨折内固定、修补外侧副韧带及伸肌总腱止点。经肘关节内侧径路固定尺骨冠状突,修复肘关节周围关节囊和内外侧副韧带损伤。最后使用肘关节铰链式外固定支架固定肱尺关节脱位,恢复肘关节同心圆稳定性。于术后1、3、6个月及随访结束时,进行影像学和临床检查评估。结果 5例平均手术时间为76min(60～150min),平均随访时间8.8个月(3～13个月)。外固定支架拆除时间6周(4～9周)。至随访末患者肘关节活动度平均为(127±25)°。按照Mayo肘关节评分平均为87分(80～95分),优2例,良3例。无浅表或深部感染、皮肤无坏死、无骨化性肌炎等并发症。结论通过手术内固定或修补肘关节稳定结构结合外固定支架维持肘关节同心圆解剖关系可以明显改善肘关节"恐怖三联征"患者肘关节的功能及预后,对此类损伤建议采用内固定结合外固定治疗。
Objective To report the surgical results of posterior dislocation of the elbow with associated fracturesof the radial head and the coronoid process of the ulna （terrible triad）. Methods Five cases of ＂terrible triad＂ of elbow treated by modified surgical techniques were reviewed retrospectively.The surgical protocol including：fixation of the radial head fractures, repair of the lateral collateral ligament complex and common extensor origin by lateral surgical approach;fixation of the coronoid process fractures,repair of the anterior capsular and medial collateral ligament by medial approach ;finally external fixation of the ulnohumeral joint with adjuvant hinged external fixation, restoring the concentric stability.Then these cases followed-up in 1,3 and 6 month and end of this research were evaluated by radiography and clinical examination.Results The average surgical time was 76 min （60-150 min）,and the mean follow-up time was 8.8 months （3- 13 months）.The removal time of external fixator was 6 weeks （4-9 weeks）.At the end of the follow-up the flexion-extension arc of the elbow averaged （127±25）°.The mean Mayor elbow performance score was 87 points （range, 80-95 points）, which corresponded to 2 excellent results,3 good results.Conclusion Our modified surgical techniques including ineternal fixation/repair and external fixation for ＂terrible triad＂ of elbow can notablely improve the function and prognosis of the elbow.Treatment with combined internal and external fixation for ＂terrible tarid＂ of elbow should be suggested.
出处
《中国骨与关节损伤杂志》
2010年第5期401-404,共4页
Chinese Journal of Bone and Joint Injury
关键词
肱尺关节
桡骨头
尺骨冠状突
肘关节“恐怖三联征”
外固定
侧副韧带
Ulnohumeral joint
Radial head
Corenoid process
Terrible triad of elbow
External fixation
Collateral ligaments
