Gonçalves Lucas Braga Jaques, Neto Jorge de Almeida E Silva, Correa Filho Mario Roberto Chaves, de Andrade Ronaldo Percope, de Andrade Marco Antônio Percope, Gomes Anderson Humberto, Vilela José Carlos Souza
Serviço de Ombro e Cotovelo, Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
Serviço de Ortopedia, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
Rev Bras Ortop. 2014 Jul 11;49(4):328-33. doi: 10.1016/j.rboe.2014.07.001. eCollection 2014 Jul-Aug.
to test the null hypothesis that patients with the terrible triad of the elbow (dislocation together with fractures of the radial head and coronoid process) who are treated with open reduction and internal fixation of the radial head have final results that are comparable with those of patients treated with arthroplasty or partial resection of the radial head.
twenty-six patients with the terrible triad of the elbow who were operated by a single surgeon were evaluated on average 23 months after the surgery (range: 16-36 months). There were 17 men and nine women of mean age 41 ± 13.4 years. The fractures of the radial head were treated by means of osteosynthesis (12 patients), arthroplasty (nine) or resection of a small fragment or no treatment (five). Fixation of the coronoid process/anterior capsule was performed in 21 patients. The lateral ligament complex (LLC) was repaired in all the patients, while the medial ligament complex (MLC) was repaired in three patients whose elbows remained unstable after treatment for the radial head and LLC, but without fixation of the coronoid process.
the mean final range of flexion and extension was 112°. The mean pronation was 70° and supination, 6°. The mean DASH score (Disabilities of the Arm, Shoulder & Hand) was 12 and mean MEPI (Mayo Elbow Performance Index) was 87. According to the MEPI scores, 21 patients (80%) had good and excellent results. There was no statistically significant difference in the results between the patients who underwent fixation of the radial head and those who underwent arthroplasty or resection of a small fragment.
there was no difference between the patients treated with arthroplasty of the radial head and those treated with other techniques.
检验零假设，即接受桡骨头切开复位内固定治疗的肘关节恐怖三联征（脱位合并桡骨头和冠状突骨折）患者的最终结果与接受桡骨头置换术或部分切除术的患者相当。
对由同一位外科医生手术的26例肘关节恐怖三联征患者进行评估，平均术后23个月（范围：16 - 36个月）。其中男性17例，女性9例，平均年龄41 ± 13.4岁。桡骨头骨折采用接骨术治疗12例，置换术治疗9例，小骨块切除或未治疗5例。21例患者进行了冠状突/前关节囊固定。所有患者均修复外侧韧带复合体（LLC），3例桡骨头和LLC治疗后肘关节仍不稳定且未固定冠状突的患者修复了内侧韧带复合体（MLC）。
最终屈伸平均活动范围为112°。平均旋前为70°，旋后为6°。平均上肢、肩部和手部功能障碍评分（DASH）为12分，平均梅奥肘关节功能指数（MEPI）为87分。根据MEPI评分，21例患者（80%）结果为优良。接受桡骨头固定的患者与接受置换术或小骨块切除术的患者结果无统计学显著差异。
桡骨头置换术治疗的患者与采用其他技术治疗的患者之间无差异。
