Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, China.
Department of Orthopedics, Hunan Aerospace Hospital, Changsha, China.
Orthop Surg. 2022 Sep;14(9):2159-2169. doi: 10.1111/os.13430. Epub 2022 Aug 5.
In order to reduce surgical scars and the risk of neurovascular injury for the treatment of terrible triad injuries of the elbow (TTI), minimally invasive and better therapeutic effect approaches are being explored to replace the conventional combined lateral and medial approach (CLMA). This study was performed to compare the clinical effect and security of the modified posterior approach (MPA) through the space of the proximal radioulnar joint vs the CLMA for treatment of TTI.
This study retrospectively analyzed 76 patients treated for TTI from January 2009 to December 2020 (MPA: n = 44; CLMA: n = 32). Treatment involved plate and screw fixation or Steinmann pin fixation for the radial head and ulnar coronoid process fractures. Surgeons only sutured the lateral ligament because the medial collateral ligament was usually integrated in the TTI. The continuous variables were compared by the independent Student t-test and the categorical variables by the χ -test or Fisher's exact test.
Both groups of patients attained a satisfactory MEPS after the operation. The MEPS (MPA: 96.82 ± 6.04 vs CLMA: 96.56 ± 5.51) was not significantly different between the two groups (p > 0.05). However, the MPA resulted in better elbow flexion and extension (MPA: 123.98 ± 10.09 vs CLMA: 117.66 ± 8.29), better forearm rotation function (MPA: 173.41 ± 6.81 vs CLMA: 120.00 ± 12.18), and less intraoperative hemoglobin (MPA: 9.34 ± 5.64 vs CLMA: 16.5 ± 8.75) and red cell volume loss (MPA: 3.09 ± 2.20 vs CLMA: 6.70 ± 2.97) (All p < 0.05). Although the CLMA had a shorter surgery time (MPA: 171.73 ± 80.68 vs CLMA: 130.16 ± 71.50) (p < 0.05), it had a higher risk of neurologic damage (MPA: 0 vs CLMA: 4) (p < 0.05). Four patients developed forearm or hand numbness after the CLMA, but no patients developed numbness after the MPA. All 76 patients were followed up for 15 months postoperatively.
The MPA through the space of the proximal radioulnar joint has more prominent advantages than the CLMA for TTI, including single scar, clear exposure, good fixation, lower risk of neurovascular injury, and better elbow joint motion. It is a safe and effective surgical approach that is worthy of clinical promotion.
为减少手术疤痕和神经血管损伤的风险，治疗肘部三联征损伤（TTI），正在探索微创和更好疗效的方法来替代传统的外侧和内侧联合入路（CLMA）。本研究旨在比较改良后侧入路（MPA）经桡尺近端关节间隙与 CLMA 治疗 TTI 的临床效果和安全性。
本研究回顾性分析了 2009 年 1 月至 2020 年 12 月收治的 76 例 TTI 患者（MPA：n=44；CLMA：n=32）。治疗包括桡骨头和尺骨冠状突骨折的钢板和螺钉固定或斯氏针固定。由于内侧副韧带通常与 TTI 融合，外科医生仅缝合外侧韧带。连续变量采用独立样本 t 检验进行比较，分类变量采用 χ 2 检验或 Fisher 确切概率法进行比较。
两组患者术后均获得满意的 MEPS。MEPS（MPA：96.82±6.04 vs CLMA：96.56±5.51）两组间差异无统计学意义（p＞0.05）。然而，MPA 组的肘关节屈伸（MPA：123.98±10.09 vs CLMA：117.66±8.29）、前臂旋转功能（MPA：173.41±6.81 vs CLMA：120.00±12.18）更好，术中血红蛋白丢失量（MPA：9.34±5.64 vs CLMA：16.5±8.75）和红细胞容积丢失量（MPA：3.09±2.20 vs CLMA：6.70±2.97）更少（均 P＜0.05）。虽然 CLMA 的手术时间更短（MPA：171.73±80.68 vs CLMA：130.16±71.50）（P＜0.05），但神经损伤风险更高（MPA：0 vs CLMA：4）（P＜0.05）。CLMA 后 4 例出现前臂或手部麻木，但 MPA 后无患者出现麻木。76 例患者均获得 15 个月的随访。
MPA 经桡尺近端关节间隙治疗 TTI 具有比 CLMA 更显著的优势，包括单一疤痕、清晰暴露、良好固定、较低的神经血管损伤风险和更好的肘关节活动度。是一种安全有效的手术方法，值得临床推广。
