肘关节“恐怖三联征”的手术治疗分析

An analysis of surgical treatment for terrible triad of the elbow

摘要:

［目的］总结肘关节恐怖三联征（terrible triad of the elbow, TTE）的手术治疗方法及疗效分析。［方法］回顾性分析本科 2017 年 7 月—2020 年 3 月手术治疗 TTE 53 例患者的临床资料，男 34 例，女 19 例；年龄 16~63 岁，平均 （40.98±10.34） 岁。采用单一外侧切口，由深至浅依次固定骨折、修复韧带。评价临床及影像结果。［结果］所有患者均顺利完成手术，术中均无严重并发症。随访 （19.00±4.65） 个月，随时间推移，VAS 评分显著下降 （P<0.001），而 MEPS 评分、肘关节屈伸 ROM、 前臂旋转 ROM 显著增加 （P<0.001）。末次随访时 53 例内、外翻应力试验均阴性。影像方面，术后 53 例患者均为桡骨轴线通过肱骨小头中心，双侧肱尺关节间隙对称；术后 3 个月和末次随访时 14 例出现异位骨化。［结论］对 TTE 采用单一外侧切口由深到浅依次修复骨折与韧带操作可获得良好的效果。

Abstract:

[Objective] To summarize the surgical strategy and clinical outcomes of terrible triad of the elbow (TTE) . [Methods] A ret- rospective study was conducted on 53 patients who underwent surgical treatment in our department for TTE from July 2017 to March 2020, including 34 males and 19 females aged from 16 to 63 years with an average of (40.98±10.34) years. A single lateral incision was used to fix the fractures and repair the ligament in layers. The clinical and imaging consequences were evaluated. [Results] All the patients were suc- cessfully operated on without serious complications. With time of the follow-up lasted for (19.00±4.65) months, the VAS scores decreased significantly (P＜0.05) , whereas MEPS score, elbow flexion-extension range of motion (ROM) and forearm rotation ROM significantly in- creased (P＜0.05) . At the latest follow-up, all the 53 patients got negative results in term of adduction and abduction stress tests. Radio- graphically, all the patients had radial axis passed through the capitulum, center, with symmetrical bilateral humeroulnar space, however, 14 patients were noted ectopic ossification at 3 months postoperatively and at the last follow-up. [Conclusion] The surgical fracture fixation and ligament repair by a single lateral incision does achieve satisfactory clinical outcomes for TTE in this study.