Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon-si, Korea.
J Orthop Trauma. 2019 May;33(5):250-255. doi: 10.1097/BOT.0000000000001425.
To identify risk factors associated with subsequent recurrent instability and to identify predictors of poor outcomes in terrible triad injury of the elbow.
Retrospective cohort study.
University trauma center.
PATIENTS/PARTICIPANTS: Seventy-six patients who were surgically treated for terrible triad injury of the elbow.
Review of charts and standardized x-ray images before surgery and 2 years after surgery. Patients were categorized into 2 groups: recurrent instability (group A) or concentric stability (group B).
Primary outcome measures were injury mechanism, time between injury and operation, fracture type, ligament injury, radial head fixation, coronoid fixation, ligament repair, period of postoperative immobilization, joint space restoration, healing progress, secondary operation, functional outcomes, and complications. Secondary outcome measures were age, sex, height, body mass index, bone mineral density, and comorbidities (hypertension and diabetes). Outcomes were measured before surgery and 2 years after surgery and were compared between groups.
Recurrent instability occurred in 19.7% of cases; revision surgeries were performed in 12 cases (80%). High-energy trauma (P = 0.012), time between injury and operation (P = 0.001), radial head comminution (P = 0.001), medial collateral injury (P = 0.041), and coronoid nonrepair (P = 0.030) were associated with recurrent instability. Posttraumatic arthritis developed more often in group A (P = 0.001).
Recurrent instability was associated with high-energy trauma, time between injury and operation, Mason type III radial head fracture, medial collateral injury, and coronoid nonrepair. Patients with recurrent instability were more likely to require secondary surgery and develop posttraumatic arthritis than those with concentric stability.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定与随后复发性不稳定相关的危险因素，并确定肘恐怖三联征损伤不良预后的预测因素。
回顾性队列研究。
大学创伤中心。
患者/参与者：76 例接受手术治疗的肘恐怖三联征损伤患者。
术前和术后 2 年回顾病历和标准化 X 线片。患者分为 2 组：复发性不稳定（A 组）或同心稳定性（B 组）。
主要结局指标为损伤机制、损伤与手术时间间隔、骨折类型、韧带损伤、桡骨头固定、冠状突固定、韧带修复、术后固定期、关节间隙恢复、愈合进展、二次手术、功能结果和并发症。次要结局指标为年龄、性别、身高、体重指数、骨密度和合并症（高血压和糖尿病）。在术前和术后 2 年进行测量，并在组间进行比较。
19.7%的病例发生复发性不稳定；12 例（80%）进行了翻修手术。高能创伤（P=0.012）、损伤与手术时间间隔（P=0.001）、桡骨头粉碎性骨折（P=0.001）、内侧副韧带损伤（P=0.041）和冠状突未修复（P=0.030）与复发性不稳定有关。A 组更常发生创伤后关节炎（P=0.001）。
复发性不稳定与高能创伤、损伤与手术时间间隔、Mason Ⅲ型桡骨头骨折、内侧副韧带损伤和冠状突未修复有关。与同心稳定性相比，复发性不稳定的患者更可能需要二次手术并发生创伤后关节炎。
预后 III 级。请参阅作者说明以获取完整的证据水平描述。
