Chiu Yen-Chun, Wu Chin-Hsien, Tsai Kun-Ling, Jou I-Ming, Tu Yuan-Kun, Ma Ching-Hou
Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
Geriatr Orthop Surg Rehabil. 2023 Mar 5;14:21514593231162193. doi: 10.1177/21514593231162193. eCollection 2023.
Treating a terrible triad injury of the elbow remains a challenge for orthopedic surgeons, especially in elderly patients due to the poor quality of the surrounding soft tissue and bony structures. In the present study, we propose a treatment protocol using an internal joint stabilizer through a single posterior approach and analyze the clinical results.
We retrospectively reviewed 15 elderly patients with terrible triad injuries of the elbow who underwent our treatment protocol from January 2015 to December 2020. The surgery involved a posterior approach, identification of the ulnar nerve, bone and ligament reconstruction, and the application of the internal joint stabilizer. A rehabilitation program was initiated immediately after the operation. Surgery-related complications, elbow range of motion (ROM), and functional outcomes were evaluated.
The mean follow-up period was 21.7 months (range, 16-36 months). ROM at the final follow-up was 130° in extension to flexion and 164° in pronation to supination. The mean Mayo Elbow Performance Score was 94 at the final follow-up. Major complications included breaking of the internal joint stabilizer in 2 patients, transient numbness over the ulnar nerve territory in one, and local infection due to irritation of the internal joint stabilizer in one.
Although the current study involved only a small number of patients and the protocol comprised two stages of operation, we believe that such a technique may be a valuable alternative for the treatment of these difficult cases.
治疗肘部恐怖三联征损伤对骨科医生来说仍然是一项挑战，尤其是对于老年患者，因为其周围软组织和骨结构质量较差。在本研究中，我们提出了一种通过单一后路使用内部关节稳定器的治疗方案，并分析其临床结果。
我们回顾性分析了2015年1月至2020年12月期间接受我们治疗方案的15例老年肘部恐怖三联征损伤患者。手术包括后路入路、尺神经识别、骨与韧带重建以及内部关节稳定器的应用。术后立即开始康复计划。评估手术相关并发症、肘关节活动范围（ROM）和功能结果。
平均随访期为21.7个月（范围16 - 36个月）。末次随访时，屈伸活动范围为130°，旋前旋后活动范围为164°。末次随访时Mayo肘关节功能评分平均为94分。主要并发症包括2例内部关节稳定器断裂、1例尺神经分布区域短暂麻木以及1例因内部关节稳定器刺激导致的局部感染。
尽管本研究仅纳入了少数患者且该方案包括两个手术阶段，但我们认为这种技术可能是治疗这些困难病例的一种有价值的替代方法。
4级。
