桡骨头置换在肘关节恐怖三联征中的应用

目的总结采用人工桡骨头置换在治疗肘关节恐怖三联征中的临床疗效。方法自2008年2月至2013年8月,采用人工桡骨头置换治疗肘关节恐怖三联征13例,其中男7例,女6例;年龄33~75岁,平均46.7岁。左侧6例,右侧7例。受伤至手术时间为2~14 d,平均7.6 d。冠突骨折按Regan-Morrey分型,Ⅰ型8例,Ⅱ型5例;桡骨头骨折按Mason分型,Ⅱ型2例,Ⅲ型11例。采用Mayo评分评价术后肘关节功能。结果 13例患者均获得随访,随访时间为12~22个月,平均15.6个月。13例患者评分,优10例,良2例,可1例。末次随访时,可见1例人工桡骨头松动,未见脱出,肘关节功能可,12例未见感染、异位骨化、人工关节松动、脱出、肘关节滑膜炎、功能障碍、旋转时疼痛等并发症。结论人工桡骨头置换在治疗肘关节恐怖三联征的短期临床应用效果良好,可早期恢复肘关节稳定性,能够使肘关节早期活动,有利于康复。

The Clinical Application of Radial Head Arthroplasty for Terrible Triad of the Elbow

Objective To summarize the clinical results of radial head arthroplasty for terrible triad of the elbow.Methods Between February 2008 and August 2013,13 cases of closed terrible triad of the elbow joint were treated by operation.There were 7 males and 6 females with an average age of 46.7 years （range,33 ～ 75 years）,an average time between injury and operation of 7.6 days（range,2 ～ 14 days）.According to Regan-Morrey classification for fractures of the ulnar coronoid,there were 8 cases of type Ⅰ,5 cases of type Ⅱ ;and according to Mason classification for fractures of the radial head,there were 2 cases of type Ⅱ,and 11 cases of type Ⅲ.The elbow joint function after surgery were evaluated by Mayo elbow performance score.Results Thirteen cases followed up 12 ～ 22 months （15.6 months on average）.According to Mayo elbow performance score,the results were excellent in 10 cases,good in 2 cases,and fair in 1 case with an excellent and good rate of 92.3％.At the time of last follow-up,1 case of loose but no dislocation of artificial radial head was observed,and its function was good.12 cases healed without infection,heterotopic ossification,artificial joint loosening,dislocation,elbow synovitis,dysfunction,and pain.Conclusion Radial head arthroplasty is an effective treatment for terrible triad of the elbow in short term.The surgical treatment of terrible the elbow joint can restore sufficiently elbow stability,allow early motion postoperatively,and enhance the functional outcome.