Liu Guanyi, Ma Weihu, Li Ming, Feng Jianxiang, Xu Rongming, Pan Zhijun
Department of Orthopedics, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou Department of Orthopedics, Ningbo 6th Hospital, Ningbo, Zhejiang, P.R. China.
Medicine (Baltimore). 2018 Apr;97(16):e0523. doi: 10.1097/MD.0000000000010523.
The aim of the present study was to investigate the efficacy of the surgical treatment of terrible triad injuries of the elbow using a modified standard surgical approach, and treatment determined by the mode and mechanism of injury, and intraoperative findings.The study was a retrospective analysis of a prospective cohort of patients presenting with terrible triad injuries of the elbow, who underwent surgical treatment between July 2009 and January 2014. All patients were treated surgically according to a modified Pugh standard protocol. Elbow functional status and range of movements were evaluated at 3 months, 6 months, 1 year, and 2 years or more after surgery. Radiographic signs of post-traumatic arthritis were rated according to the Broberg and Morrey system.Our series included a final cohort of 29 males and 13 females with a mean age of 48.23 ± 10.95 years at the time of injury. The mean follow-up period was 30.47 ± 7.65 months. The mean flexion-extension arc was 107° ± 22°, and the average forearm rotation arc was 145° ± 14°. The mean Mayo Elbow Performance Score was 88 ± 10 points (range 55 to 100 points), with excellent results in 24 elbows, good results in 16, and poor results in 2. Functional results of the elbow improved significantly from 3 months postoperatively (P < .05), but tended to plateau from 1 year after surgery. Thirteen patients had radiographic signs of arthrosis (9 grade 1, 4 grade 2). Postoperative complications were local infection around the incision (n = 1), transient postoperative median nerve paralysis (n = 1), and postoperative posterior interosseous nerve paralysis (n = 1). Four patients required further surgery. Five patients had evidence of heterotopic ossification.Overall, we show that slight modifications to Pugh standard protocol for the surgical treatment of terrible triad injuries can lead to good to excellent results, although there were a good number of complications. The ideal surgical approach and treatment should be based on the mode and mechanism of injury, and intraoperative findings, and modifying the standard surgical treatment approach for terrible triad elbow injuries may be beneficial.
本研究的目的是探讨采用改良的标准手术入路治疗肘关节恐怖三联征损伤的疗效，以及根据损伤方式、机制和术中发现确定的治疗方法。该研究是对2009年7月至2014年1月间接受手术治疗的肘关节恐怖三联征患者的前瞻性队列进行的回顾性分析。所有患者均按照改良的Pugh标准方案进行手术治疗。在术后3个月、6个月、1年、2年及以上评估肘关节功能状态和活动范围。根据Broberg和Morrey系统对创伤后关节炎的影像学征象进行评级。我们的系列研究最终纳入了29例男性和13例女性患者，受伤时的平均年龄为48.23±10.95岁。平均随访期为30.47±7.65个月。平均屈伸弧为107°±22°，平均前臂旋转弧为145°±14°。平均Mayo肘关节功能评分88±10分（范围55至100分），24例肘关节结果为优，16例为良，2例为差。肘关节功能结果术后3个月时显著改善（P<0.05），但术后1年趋于平稳。13例患者有关节病的影像学征象（9例为1级，4例为2级）。术后并发症包括切口周围局部感染（n=1）、术后短暂性正中神经麻痹（n=1）和术后骨间后神经麻痹（n=1）。4例患者需要进一步手术。5例患者有异位骨化迹象。总体而言，我们表明，尽管有相当数量的并发症，但对Pugh标准方案进行轻微修改以手术治疗肘关节恐怖三联征损伤可取得良好至优异的结果。理想的手术入路和治疗应基于损伤方式、机制和术中发现，对肘关节恐怖三联征损伤的标准手术治疗方法进行修改可能是有益的。
