前内联合外侧入路治疗肘恐怖三联征损伤△（开放获取）

Anteromedial and lateral approaches for surgical treatment of terrible triad of elbow (OA)

摘要:

[目的] 探讨前内联合外侧入路治疗肘恐怖三联征损伤的临床疗效。[方法] 回顾性分析 2017 年 10 月—2022 年 10 月福建医科大学附属闽东医院骨科采用前内联合外侧入路治疗的 15 例肘恐怖三联征损伤患者的临床资料。评价临床及影像结果。[结果] 所有患者均顺利完成手术，手术时间平均 （218.6±70.5） min，术中出血量平均 （150.0±116.5） ml。随访时间平均 （15.1±4.1）个月，与术前相比，术后 3 个月及末次随访时，患者 VAS 评分 [(8.1±0.9), (1.3±0.6), (0.0±0.0), P＜0.001] 显著减少、内翻应力试验 [例, -/1+/2+/3+, (0/7/7/1), (12/3/0/0), (15/0/0/0), P＜0.001]、外翻应力 [例, -/1+/2+/3+, (0/1/12/2), (13/2/0/0), (15/0/0/0), P＜ 0.001] 均显著改善。与术后 3 个月相比，末次随访时，Mayo 评分 [(77.7±8.2), (94.3±5.9), P＜0.001] 显著增加，肘伸屈 ROM、前臂旋转 ROM 无显著变化（P＞0.05）。影像方面，与术前相比，术后 3 个月及末次随访时，肱尺对合 [同心/偏心/脱位, (1/9/5), (12/3/ 0), (15/0/0), P＜0.001] 显著改善。[结论] 经旋前圆肌与桡侧腕屈肌的肘前内侧入路治疗尺骨冠状突骨折安全有效，结合外侧入路可较好治疗肘关节损伤恐怖三联征。

Abstract:

[Objective] To investigate the clinical efficacy of anteromedial approach combined with lateral approach in surgical treatment of terrible triad of the elbow (TTE). [Methods] A retrospective study was done on 15 patients who had TTE treated surgically through anteromedial approach combined with lateral approach in our hopsital from October 2017 to October 2022. Clinical and imaging data were evaluated. [Results] All the 15 patients underwent operation smoothly, with average operation time of (218.6±70.5) min, and average intraoperative blood loss of (150.0±116.5) ml, and followed up for (15.1±4.1) months in an average. As time went preoperatively, 3 months after surgery and the last follow-up, the VAS score significantly reduced [(8.1±0.9), (1.3±0.6), (0), P＜0.001] , while the varus stress test [-/1+/2+/ 3+, (0/7/7/1), (12/3/0/0), (15/0/0/0), P＜0.001], and valgus stress test [-/1+/2+/3+, (0/1/12/2), (13/2/0/0), (15/0/0/0), P＜0.001] significantly improved. Compared with that 3 months after surgery, Mayo score [(77.7±8.2), (94.3±5.9), P＜0.001] was significantly increased at the last follow-up, whereas the elbow flexion-extension ROM and forearm rotation ROM remained unchanged (P＞0.05). Radiographically, the humeroulnar congruence [concentric/eccentric/dislocation, (1/9/5), (12/3/0), (15/0/0), P＜0.001] significantly improved 3 months after surgery and at the last follow-up compared with that preoperatively. [Conclusion] This combination, treating ulnar coronoid fractures through anteromedial approach passing between teres pronator and the flexor carpi radialis, and treating the radial head fracture through lateral approach, is safe and effective treatment for TTE.