Zha Ye-Jun, Xiao Dan, Hua Ke-Han, Sun Wei-Tong, Gong Mao-Qi, Li Ting, Chen Chen, Jiang Xie-Yuan
Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, China.
Ann Transl Med. 2021 Aug;9(15):1232. doi: 10.21037/atm-21-2542.
This study aimed to report the surgical techniques and results of treating coronoid process and radial head fracture combined with dislocation of the elbow (terrible triad of the elbow) using a single lateral incision, known as the extensor digitorum communis (EDC) split approach.
A retrospective analysis was performed of 109 patients with terrible triad of the elbow who had been treated by the authors from January 2013 to December 2019. The participants included 67 males and 42 females, with a mean age of 42.2 years (14-71 years). All participants were treated via a single lateral approach. The coronoid process was fixated with Kirschner wires combined with anterior capsule suture lasso fixation. For the radial head fracture, 58 cases were fixated by AO headless cannulated screw (AO HCS) and 51 cases by acumed radial head replacement. In repair of the lateral collateral ligament (LCL) complex and the common extensor tendon, 28 cases used ETHIBOND suture through bone holes at the humeral lateral epicondyle, and the other 81 cases used suture anchors. No medial collateral ligament was repaired. A total of 46 participants were fixated with a Stryker dynamic joint distractor (DJD) II hinged external fixator to protect the bone and soft tissue.
All participants were followed up from 6 to 60 months (mean, 36.1 months). Their elbow range of flexion and extension averaged 123.4°±20.7°, forearm rotation 151.0°±25.6°, and Mayo elbow performance score (MEPS) 92.3±8.8. There were 22 participants (19.5%) with ulnar nerve symptoms, 16 (14.7%) who had elbow stiffness, and 7 underwent secondary surgery, including 6 removals of internal fixation, 5 arthrolyses of the elbow, and 2 ulnar neurolyses.
Coronoid fractures, radial head fractures, and LCL injuries of the terrible triad of the elbow can be treated satisfactorily through a lateral minimal incision, combined with a hinged external fixation if necessary.
本研究旨在报告采用单一外侧切口（即指总伸肌劈开入路）治疗冠状突和桡骨头骨折合并肘关节脱位（肘关节恐怖三联征）的手术技术及结果。
对2013年1月至2019年12月期间作者治疗的109例肘关节恐怖三联征患者进行回顾性分析。参与者包括67名男性和42名女性，平均年龄42.2岁（14 - 71岁）。所有参与者均通过单一外侧入路进行治疗。冠状突采用克氏针固定并结合前关节囊缝合套索固定。对于桡骨头骨折，58例采用AO无头空心螺钉（AO HCS）固定，51例采用acumed桡骨头置换。在修复外侧副韧带（LCL）复合体和伸肌总腱时，28例通过肱骨外侧髁骨孔用ETHIBOND缝线缝合，另外81例使用缝线锚钉。未修复内侧副韧带。共有46名参与者使用史赛克动态关节撑开器（DJD）II型铰链式外固定器进行固定以保护骨骼和软组织。
所有参与者均随访6至60个月（平均36.1个月）。他们的肘关节屈伸范围平均为123.4°±20.7°，前臂旋转151.0°±25.6°，梅奥肘关节功能评分（MEPS）为92.3±8.8。有22名参与者（19.5%）出现尺神经症状，16名（14.7%）肘关节僵硬，7名接受了二次手术，包括6例内固定取出、5例肘关节松解和2例尺神经松解。
肘关节恐怖三联征的冠状突骨折、桡骨头骨折和LCL损伤可通过外侧小切口得到满意治疗，必要时结合铰链式外固定。
