摘要
目的探讨铰链式外固定架联合微型钢板治疗肘关节恐怖三联征的疗效。方法 2008年8月-2011年6月,采用铰链式外固定架联合微型钢板治疗11例肘关节恐怖三联征患者。男9例,女2例;年龄22～56岁,平均34岁。致伤原因:高处坠落伤8例,交通事故伤3例。均为闭合性损伤。受伤至手术时间8 h～7 d,平均3.7 d。桡骨小头骨折根据Mason分型标准均为Ⅳ型,伴肘关节后脱位。尺骨冠状突骨折采用Regan-Morrey分型标准:Ⅰ型3例,Ⅱ型3例,Ⅲ型5例。结果术后切口均Ⅰ期愈合,无神经损伤发生。患者均获随访,随访时间12～20个月,平均15个月。术后12周2例出现钉道感染,术后4个月1例出现肘关节轻度异位骨化。X线片复查示骨折均愈合,愈合时间8～20周,平均16周。随访期间均无复发性肘关节脱位或不稳发生。术后12个月,肘关节活动范围:伸0～25°,平均10°;屈120～145°,平均135°;前臂旋前50～90°,平均70°;前臂旋后50～80°,平均60°。根据Mayo肘关节功能评分标准,获优5例,良4例,可2例,优良率81.8%。结论铰链式外固定架联合微型钢板固定能提高肘关节恐怖三联征术后关节稳定性,有利于早期功能锻炼,降低肘关节复杂性损伤的致残率。
Objective To investigate the effectiveness of hinged external fixator with mini-plate to treat terrible triad of the elbow. Methods Between August 2008 and June 2011, 11 patients with terrible triad of the elbow were treated with hinged external fixator combined with mini-plate. There were 9 males and 2 females, aged 22-56 years （mean, 34 years）. The injuries were caused by falling from height in 8 cases and traffic accident in 3 cases. All patients were closed injury. The time from injury to operation varied from 8 hours to 7 days （mean, 3.7 days）. According to Mason classification standard, all radial head fractures were type IV and complicated by posterior dislocation of the elbow; according to Regan-Morrey classifcation standard, ulna coronary process fractures were type I in 3 cases, type II in 3 cases, and type III in 5 cases. Results All the patients achieved primary healing of incision after operation and no nerve injury occurred. The patients were followed up 12-20 months （mean, 15 months）. Two cases had screw channel infection after 12 weeks of operation, and 1 case had mild heterotopic ossification of the elbow after 4 months of operation. X-ray films showed that all fractures healed from 8 to 20 weeks （mean, 16 weeks）. No recurrent dislocation or instability of the elbow occurred. At 12 months after operation, the elbow range of motion （ROM） were 120-145° （mean, 135°） in flexion, 0-25°（mean, 10°） in extension, 50-90° （mean, 70°） in pronation, and 50-80° （mean, 60°） in supination. According to Mayo elbow function evaluation standard, the results were excellent in 5 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 81.8%. Conclusion Hinged external fixator with mini-plate can enhance postoperative stability of the elbow. This therapy is beneficial to early functional exercise and obviously decrease the disability rate caused by complex damage on the elbow.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2013年第2期151-154,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
肘关节恐怖三联征
铰链式外固定架
微型钢板
内固定
Terrible triad of the elbow Hinged external fixator Mini-plate Internal fixation
