Duke University Medical Center, Durham, NC 27710, USA.
J Bone Joint Surg Am. 2011 Oct 19;93(20):1873-81. doi: 10.2106/JBJS.I.01673.
Terrible triad injuries consist of a posterior dislocation of the elbow, a coronoid fracture, and a radial head fracture. The coronoid plays a pivotal role as an anterior buttress, yet the optimal management of the coronoid fracture remains unknown. We hypothesize that suture lasso fixation of the coronoid fracture leads to fewer complications and improved outcomes compared with screw or suture anchor fixation techniques.
A retrospective chart review performed at three tertiary care centers identified forty consecutive patients treated for terrible triad injuries of the elbow with a minimum follow-up of eighteen months (mean, twenty-four months; range, eighteen to fifty-three months). All patients were managed with a standard approach consisting of: (1) repair or replacement of the radial head; (2) repair of the lateral ulnar collateral ligament (LUCL) of the elbow; and (3) repair of the coronoid fracture with one of two techniques: Group I (n = 28) consisted of the "lasso" technique and Group II (n = 12) consisted of open reduction and internal fixation (ORIF) with screws or suture anchors.
For the study population, the mean postoperative arc of elbow motion was 115° (range, 75° to 140°), the average Disabilities of the Arm, Shoulder and Hand (DASH) score was 16 (range, 0 to 43), and the average Broberg-Morrey score was 90 (range, 64 to 100). For repair of the coronoid fracture, the suture lasso technique was more stable than the other techniques intraoperatively, both before (p < 0.05) and after (p < 0.05) LUCL repair, and at the final follow-up (p < 0.05). ORIF was associated with a higher prevalence of implant failure (p < 0.05), and suture anchors were associated with a higher prevalence of malunion and nonunion (p < 0.05).
For terrible triad injuries, greater stability with fewer complications was achieved with use of the suture lasso technique for coronoid fracture fixation.
三联征损伤包括肘部后脱位、冠状突骨折和桡骨头骨折。冠状突作为前支撑具有关键作用，但冠状突骨折的最佳治疗方法仍不清楚。我们假设，与螺钉或缝线锚定固定技术相比，缝线套索固定冠状突骨折可减少并发症并改善结局。
在三家三级护理中心进行的回顾性图表审查中，确定了 40 例连续接受肘部三联征损伤治疗的患者，随访时间至少为 18 个月（平均 24 个月；范围为 18 至 53 个月）。所有患者均采用标准方法治疗，包括：（1）修复或更换桡骨头；（2）修复肘部外侧尺侧副韧带（LUCL）；（3）用以下两种技术之一修复冠状突骨折：I 组（n = 28）由“套索”技术组成，II 组（n = 12）由切开复位内固定（ORIF）组成，使用螺钉或缝线锚定。
对于研究人群，术后肘部运动弧的平均为 115°（范围为 75°至 140°），平均残疾的手臂，肩和手（DASH）评分是 16（范围为 0 至 43），平均 Broberg-Morrey 评分为 90（范围为 64 至 100）。对于冠状突骨折的修复，缝线套索技术在术中比其他技术更稳定，在 LUCL 修复前后（均 p <0.05）以及最终随访时（p <0.05）。ORIF 与更高的植入物失败发生率相关（p <0.05），而缝线锚钉与更高的畸形愈合和不愈合发生率相关（p <0.05）。
对于三联征损伤，使用缝线套索技术固定冠状突骨折可获得更大的稳定性和更少的并发症。
