Meena Mukesh Kumar, Singh Karmbeer, Meena Sanjay, Kumbhare Chetan, Chouhan Dushyant
Department of Orthopedics, Lady Hardinge Medical College(LHMC) and Associated Hospitals, New Delhi, India .
Bull Emerg Trauma. 2020 Jan;8(1):4-9. doi: 10.29252/beat-080102.
To find out which surgical approach, optimize the functional outcomes and reduce the risk of complications in terrible triad of elbow".
Medline, EMBASE, Cochrane Library, and Google Scholar were searched to identify relevant studies, which were included if they were retrospective or prospective in design, involved participants who had terrible triad of elbow (TTIE) that compared lateral approach (LA) with combined lateral and anteromedial approach (CML), and were published in English. Outcomes of interest were functional outcomes, complications, and operative time.
Four studies, involving 470 patients were included in the systematic review. Mean follow up after surgery was typically 24 to 30 months. We found significant more range of motion (ROM) of elbow in CML as compared to LA group (MD: -14.21, 95% CI: -21.13 to-7.29, <0.00001). There was significant more forearm rotation in CML as compared to LA group (MD: -18.88, 95% CI: -32.35 to -5.40, <0.00001). Mayo elbow performance score (MEPS) was significantly more in CML (MD: -3.31, 95% CI: -7.23 to 0.62, =0.00001). Blood loss, operative time, VAS and complications were more in CML group; however, the difference was not significant. The heterogeneity of the study and synthesizing retrospective data were the primary limitations.
Our analysis demonstrated that combined lateral and medial approach had significantly more elbow ROM and forearm rotation. The combined approach also had significantly more MEPS. However, using combined approach significantly increased the operative time.
明确哪种手术入路能优化功能预后并降低肘关节恐怖三联征的并发症风险。
检索Medline、EMBASE、Cochrane图书馆和谷歌学术以识别相关研究，纳入设计为回顾性或前瞻性、涉及肘关节恐怖三联征（TTIE）患者且比较了外侧入路（LA）与外侧联合前内侧入路（CML）并以英文发表的研究。感兴趣的结局包括功能预后、并发症和手术时间。
系统评价纳入了4项研究，共470例患者。术后平均随访时间通常为24至30个月。我们发现，与LA组相比，CML组肘关节的活动范围（ROM）明显更大（MD：-14.21，95%CI：-21.13至-7.29，<0.00001）。与LA组相比，CML组前臂旋转明显更多（MD：-18.88，95%CI：-32.35至-5.40，<0.00001）。CML组的梅奥肘关节功能评分（MEPS）明显更高（MD：-3.31，95%CI：-7.23至0.62，=0.00001）。CML组的失血量、手术时间、视觉模拟评分（VAS）和并发症更多；然而，差异不显著。研究的异质性和回顾性数据的综合是主要局限性。
我们的分析表明，外侧联合内侧入路的肘关节ROM和前臂旋转明显更多。联合入路的MEPS也明显更高。然而，使用联合入路显著增加了手术时间。
