单入路与双入路治疗肘恐怖三联征的疗效比较：一项回顾性研究。

Comparison of a single approach versus double approaches for the treatment of terrible traid of elbow-A retrospective study.

机构信息

Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO.109, Xue Yuan West Road, Wenzhou, Zhejiang Province, 325000, China.

出版信息

Int J Surg. 2018 Mar;51:49-55. doi: 10.1016/j.ijsu.2018.01.012. Epub 2018 Feb 3.

DOI:10.1016/j.ijsu.2018.01.012

PMID:29367033

Abstract

INTRODUCTION

Dislocation of the elbow associated with radial head and coronoid fracture, the so-called "terrible triad" of the elbow, is challenging to treat and has a history of complicated outcomes. This study is to compare the clinical outcome of a single lateral approach-the extensile splitting extensor digitorum communis (EDC) approach and combined lateral and medial (CML) approaches for the treatment of terrible traid of the elbow (TTE).

MATERIAL AND METHODS

After appropriate exclusion, 60 TTE patients (28 patients in the EDC group, 32 patients in the CML group) from 2009 January to 2015 August were reviewed in this study. All included patients underwent open reduction, lateral collateral ligament complex repair, and postoperative function exercise. Surgical time, intraoperative blood loss, postoperative pain, elbow motion, MEPS score and complication rate were recorded and compared.

RESULT

There were significant differences in surgery time (P < 0.05) and ulnar nerve lesion symptom, no patient suffered ulnar nerve lesion symptom in EDC group, but 5 patients in CML group suffered it. No differences were found in intraoperative blood loss, postoperative pain and heterotopic ossification (P > 0.05). Mean follow-up was 26.1 months (from 24 to 30 months), at the final follow-up, 2 patients in EDC group and 4 patients in CML group required elbow release operation, mean flexion and extension (124.1 ± 14.6°and 8.3 ± 5.3°), pronation and supination (73.4 ± 5.3° and 74.4 ± 6.0°) in EDC group were higher than CML group (114.2 ± 15.0° and 17.6 ± 8.0°, 69.2 ± 6.9° and 70.4 ± 7.5°, P < 0.05). Besides, MEPS score in the former group was also higher than the latter group (91.8 ± 4.5 to 84.4 ± 5.2, P < 0.01).

CONCLUSION

The single lateral approach achieved better function recovery than combined lateral and medial approach, decreasing the risk of ulnar nerve lesion and surgery time for the treatment of TTE.

摘要

简介

肘部的脱位伴桡骨头和冠状突骨折，即所谓的肘部“恐怖三联征”，治疗具有挑战性，且其预后复杂。本研究旨在比较单一外侧入路（伸肌总腱劈开 Extensor Digitorum Communis，EDC）和外侧联合内侧入路（Lateral and Medial，CML）治疗肘部恐怖三联征（TTE）的临床效果。

材料与方法

经过适当的排除，我们回顾性分析了 2009 年 1 月至 2015 年 8 月间的 60 例 TTE 患者（EDC 组 28 例，CML 组 32 例）。所有纳入的患者均接受了切开复位、外侧副韧带复合体修复和术后功能锻炼。记录并比较手术时间、术中失血量、术后疼痛、肘部运动、MEPS 评分和并发症发生率。

结果

EDC 组手术时间明显短于 CML 组（P < 0.05），且 EDC 组无尺神经损伤症状，而 CML 组有 5 例出现尺神经损伤症状。两组术中出血量、术后疼痛和异位骨化无明显差异（P > 0.05）。平均随访时间为 26.1 个月（24-30 个月），末次随访时，EDC 组有 2 例、CML 组有 4 例需要行肘部松解术，EDC 组的平均屈伸（124.1 ± 14.6°和 8.3 ± 5.3°）、旋前旋后（73.4 ± 5.3°和 74.4 ± 6.0°）均高于 CML 组（114.2 ± 15.0°和 17.6 ± 8.0°，69.2 ± 6.9°和 70.4 ± 7.5°，P < 0.05）。此外，EDC 组的 MEPS 评分也高于 CML 组（91.8 ± 4.5 比 84.4 ± 5.2，P < 0.01）。