肘关节"可怕三联征"的诊断与治疗

目的 探讨肘关节"可怕三联征"的诊断要点、手术治疗原则及效果.方法 回顾性分析自2005年3月至2008年1月收治的27例肘关节"可怕三联征"患者的病历资料及随访结果,男19例,女8例;平均年龄38(14～72)岁.所有患者均采取手术治疗,23例采用单纯外侧入路,3例采用外侧加内侧入路,1例采用肘后正中入路.所有患者平均随访17.5(6～33)个月,随访内容包括:病情主诉、肘关节屈伸活动度、前臂旋转活动度、腕关节活动度、双侧握力以及X线片情况.用MEPS(Mayo Elbow Perfof-mance Score)和Broberg & Morrey评分对肘关节功能进行评分;用Morrey等提出的"5%"校正值对主力侧和非主力侧的握力标准化后进行比较.结果 所有患者在未次随访时患侧肘关节均没有明显疼痛及不稳定.患侧肘关节伸屈活动范围平均为107°(30°～150°).患侧前臂旋前-旋后活动范围平均为147°(0°～220°).患肢握力较健侧平均减少13.7%.MEPS评分平均为93.4(72～100)分,优良率92.6%.Broberg＆Morrey评分平均为91.2(68～100)分,优良率88.9%.结论 对肘关节"可怕三联征"的诊断要紧扣其定义,且须与肘关节其它损伤相鉴别.对肘关节"可怕三联征"应采用手术治疗,大多采用单纯外侧入路即可完成,必要时可加用内侧入路.治疗原则为重建肘关节同心圆性中心复位及可靠的稳定性、对桡骨头、冠状突骨折尽量进行复位内固定并重视对软组织的处理.

The terrible triad of the elbow: diagnosis and treatment

Objective To discuss the diagnosis and surgical treatment of the terrible triad of the elbow. Methods Twenty-seven patients with the terrible triad of the elbow were retrospectively evaluated. There were 8 females and 19 males, with an average age of 38 years (range, 14-72 years). Twenty-three patients were treated with a single Koeher approach, 3 with a lateral approach combined with a medial approach and 1 with posterior median approach. All patients were followed up for clinical examination, functional evaluation and radiographs. They were evaluated with Mayo Elbow Performance Score (MEPS) and system of Broberg & Morrey. The radiographs of the last follow-up were evaluated with the Broberg & Money gradations of roentgenographic evidence of degenerative arthritis at the elbow. The grip strength difference between the dominant and non-dominant arms was normalized for comparison according to Money's study. Results No patient complained pain at a mean follow-up of 17.5 months (range, 6-33 months). They had an average of 126° (range, 80° to 150°) of flexion of the elbow and 19° (range, 0° to 70°) to full extension. The average ulnohumeral motion was 107° (range, 30° to 150°). The average motion of forearm rotation was 147° (range, 0° to 220°). The average MEPS was 93.4 points (range, 72 to 100 points). The average functional rating index of system of Broberg & Morrey was 91.2 points (range, 68 to 100 points). Conclusion The diagnosis of the terrible triad of the elbow requires careful differentiation from other elbow injuries. Most operations of the terrible triad of the elbow can be accomplished with a single Kocher approach. With operative treatment, the surgeon should attempt to restore the reduction and stability of the elbow, preserve the radial head when possible and try to perform internal fixation of coronoid fracture. It is important to repair soft tissue injury.