Du Jun-Feng, Zhu Yang-Yi
Department of Orthopaedics, Shangyu People's Hospital, Shaoxing, Zhejiang, China.
Zhongguo Gu Shang. 2014 Nov;27(11):896-9.
To study therapeutic effects of anteromedial approach combined with lateral approach for the treatment of terrible triad of elbow.
From November 2009 to March 2013,17 patients with terrible triad of elbow were treated through anteromedial approach combined with lateral approach. There were 11 males and 6 females, with an average age of 36.6 years old, ranging from 22 to 68 years old. Ten patients had fractures in the left side and 7 patients had fractures in the right side. All of which were close fractures. Coronoid process fractures were reduced and treated with internal fixation through the anteromedial approach, and the incision was located between radiocarpus and cubitalis grailis. In order to expose the lateral collateral ligament joint capsule and capitulum radii, Kocher approach was used with the incision between triceps brachii muscle and brachioradialis muscle along condylus lateralis humeri, down to posterior side between anconeus muscle and extensor carpi ulnaris muscle. Then capitulum radii fractures were treated with internal fixation using miniature plates and screws, and lateral collateral ligament complexes were repaired using fasciole rivets. Mayo elbow performance score (MEPS) was used to evaluate clinical effects at the latest follow-up.
All the patients were followed up, and the duration ranged from 13 to 24 months,with a mean of 12.4 months. At the latest follow-up, the average flexion angle of all patients was (134.0 ± 8.8) degrees; the average extension angle was (6.4 ± 2.3) degrees. According to the Mayo criteria system, the average total score was 91.8 ± 7.9, including pain score 42.4 ± 5.9, range of motion score 17.6 ± 2.6, joint stability score 9.7 ± 1.2, and functional score 22.1 ± 2.5; 13 patients got an excellent result and 4 good. Two patients had transient ulnar nerve palsy, and 1 patient had heterotopic ossification. There were no complications such as infection, nonunion, elbow residual instability, dislocation and elbow stiffness.
The operation through anteromedial approach combined with lateral approach for the treatment of terrible triad of elbow has advantages of providing both bone and soft-tissue stability simultaneously, allowing early exercise and improving early functional recovery.
探讨肘前内侧入路联合外侧入路治疗肘关节恐怖三联征的疗效。
2009年11月至2013年3月，采用肘前内侧入路联合外侧入路治疗17例肘关节恐怖三联征患者。其中男11例，女6例，平均年龄36.6岁，年龄范围22～68岁。左侧骨折10例，右侧骨折7例。均为闭合性骨折。经肘前内侧入路复位并内固定冠状突骨折，切口位于腕桡侧与肱桡肌之间。为显露外侧副韧带关节囊及桡骨小头，采用Kocher入路，切口沿肱骨外侧髁位于肱三头肌与肱桡肌之间，向下至尺骨鹰嘴肌与尺侧腕伸肌之间后侧。然后用微型钢板和螺钉内固定桡骨小头骨折，用筋膜铆钉修复外侧副韧带复合体。末次随访时采用Mayo肘关节功能评分（MEPS）评估临床疗效。
所有患者均获随访，随访时间13～24个月，平均12.4个月。末次随访时，所有患者平均屈曲角度为（134.0±8.8）°；平均伸展角度为（6.4±2.3）°。根据Mayo标准系统，平均总分91.8±7.9，其中疼痛评分42.4±5.9，活动范围评分17.6±2.6，关节稳定性评分9.7±1.2，功能评分22.1±2.5；优13例，良4例。2例出现短暂性尺神经麻痹，1例出现异位骨化。无感染、骨不连、肘关节残留不稳定、脱位及肘关节僵硬等并发症。
肘前内侧入路联合外侧入路治疗肘关节恐怖三联征具有同时提供骨与软组织稳定性、允许早期活动及促进早期功能恢复的优点。
