内侧副韧带加强重建后桡骨小头切除治疗青年肘关节恐怖三联征患者疗效观察(1)
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【摘要】 目的 报告应用侧副韧带修补重建并桡骨小头切除手术方式治疗青年肘关节恐怖三联征、桡骨小头粉碎骨折患者的疗效观察。 方法 自2005年11月至2009年10月,本院共收治肘关节三联征损伤3例。桡骨小头骨折按Mason法分类均为III型。3例患者均行冠状突固定、肘内外侧副韧带、关节囊修补、内侧副韧带加强、重建并桡骨小头切除术,术后克氏针辅助固定肱尺关节于屈肘90°前臂旋转中立位,石膏固定3周,然后拔除克氏针,去除石膏,开始屈伸和旋转康复训练。 结果 3例患者均随访1年以上,骨折愈合,按照Broberg和Morrey的肘关节功能评分2例为良,1例为可。 结论 肘关节恐怖三联征伴有桡骨小头粉碎骨折的青年患者,韧带及关节囊的重建异常重要,桡骨小头置换应当审慎,在确保韧带重建满意的情况下切除桡骨小头并未造成肘关节明显功能障碍。
【关键词】 肘关节恐怖三联征; 内侧副韧带重建; 桡骨小头切除
Reconstruction of the medial collateral ligament plus radial head resection in the treatment of terrible triad of the elbow for young patients
ZHANG Qian, LVLing-yan, SHANG Bo,et al.Liaocheng Second People’s Hospital,Shandong Province Linqing City,252601,China
【Abstract】 Objective To observe the results of medial collateral ligament reconstruction plus radial head resection in the treatment of terrible triad of the elbow for young patients.Methods From November 2005 to October 2009,3 cases of terrible triad of the elbow were treated in our hospital. The radial head fractures were classified in type III according to Mason classification. All patients underwent coronoid fixation,collateral ligament and joint capsule repair,medial collateral ligament reconstruction and radial head resection. Postoperatively Kirschner wire and the plaster was applied for elbow stabilization for 3 weeks after operation,in position with elbow flexion in 90 degrees and forearm rotation in neutral,and then removal of Kirschner wire and the plaster. Then physical exercise and rehabilitation program were carried out.Results 3 patients were followed up for more than 1 year with fracture healing. The functional outcome in 3 cases was excellent in 2 and good in 1 according to Broberg and Morrey Elbow Score. Conclusion It is exceptionally important of the reconstruction of collateral ligaments and joint capsule in the treatment of elbow terrible triad associated with radial head comminuted fracture for young patients. Radial head replacement should be cautious. Radial head resection under the premise of satisfactory ligament reconstruction does not cause significant elbow dysfunction.
【Key words】 Terrible triad of the elbow;Reconstruction of the medial collateral ligament; Radial head resection
肘关节在遭受严重高能量损伤时出现肘关节后脱位、尺骨冠状突骨折并桡骨小头骨折等症状,称为“肘关节恐怖三联征”(terribletriadoftheeblow)。该概念首先由Hotchk iss在1996年提出[1]。而国内则由张世民等在2005年介绍了这一创伤骨科新概念[2]。该种损伤在临床较少见,且对肘关节功能影响较大,作者所在科室自2005年11月至2009年10月共收治这类损伤3例,均为高处坠落伤,3例患者均为青年,于伤后24～72 h内行手术治疗,术后随访均1年以上,肘关节骨折愈合,未出现明显肘外翻及不稳情况 ......
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