摘要
目的探讨手术治疗肘关节恐怖三联征的方法和临床疗效。方法 2006年10月-2010年6月,收治肘关节恐怖三联征患者11例。男8例,女3例;年龄21～53岁,平均32岁。摔伤4例,交通事故伤7例。伤后30 min～9 d入院。尺骨冠突骨折按Regan-Morrey分型标准:Ⅰ型5例,Ⅱ型5例,Ⅲ型1例。桡骨头骨折按Mason分型标准:Ⅰ型4例,Ⅱ型5例,Ⅲ型2例。肘关节屈伸活动度为(63±9)°,前臂旋转活动度为(71±8)°。手术采用肘内外侧联合入路行骨折复位内固定。术后石膏托固定肘关节于屈曲90°、前臂中立位,7～10 d后开始被动功能锻炼,4周拆除石膏托行主动功能锻炼。结果术后患者切口均Ⅰ期愈合。患者均获随访,随访时间7～27个月,平均14.5个月。X线片检查示骨折复位良好,于8～19周达临床愈合,平均11周。3例术后6个月出现肘关节轻度异位骨化,未作特殊处理;1例术后18个月出现肘关节轻度退行性改变,经康复锻炼后无进展。末次随访时,肘关节屈伸活动度为(103±14)°,前臂旋转活动度(122±13)°,与术前比较差异均有统计学意义(P<0.05),与健侧比较差异均无统计学意义(P>0.05)。根据Mayo肘关节功能评分标准,获优5例,良5例,一般1例,优良率90.9%。结论肘关节恐怖三联征外科手术治疗能有效恢复肘关节稳定,可术后早期活动,促进关节功能恢复。
Objective To explore the operation procedure and effectiveness of terrible triad of the elbow joint. Methods Between October 2006 and June 2010, 11 cases of closed terrible triad of the elbow joint were treated by operation. There were 8 males and 3 females with an average age of 32 years （range, 21-53 years）. The mechanism of injury was falling from height in 4 cases and traffic accident in 7 cases. The time from injury to admission was 30 minutes to 9 days. According to Regan-Morrey classification for fractures of the ulnar coronoid, there were 5 cases of type Ⅰ, 5 cases of type Ⅱ, and 1 case of type Ⅲ; and according to Mason classification for fractures of the radial head, there were 4 cases of type Ⅰ, 5 cases of type Ⅱ, and 2 cases of type Ⅲ. The elbow joint range of motion （ROM） was （63±9）° at flexion and extension, and the forearm ROM was （71 ± 8）° at pronation and supination. All cases underwent reduction and fixation by lateral approach combined with medial approach according to McKeeps operation process. After operation, the affected limb was immobilized with plaster at elbow joint flexion of 90° and in forearm neutral position, then passive physical exercises were carried out, and finally active physical exercises were done after removing plaster at 4 weeks. Results All incisions healed by first intention. Eleven cases were followed up 7-27 months （14.5 months on average）. The X-ray films showed good reduction, the clinical healing time was 8-19 weeks with an average of 11 weeks. Mild ectopic ossification of the elbow joint occurred in 3 cases at 6 months after operation, mild degenerative change in 1 case at 18 months after operation. At last follow-up, the elbow joint ROM was （103±14）° at flexion and extension, and the forearm ROM was （122±13）° at pronation and supination, showing no significant difference when compared with the values of normal elbow joint （P 〉 0.05） and significant difference when compared with the preoperative values of affecte
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2011年第8期964-967,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
肘关节
恐怖三联征
尺骨冠突骨折
桡骨头骨折
Elbow joint Terrible triad Ulnar coronoid fracture Radial head fracture
