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[可怕三联征损伤]

[Terrible triad injuries].

作者信息

Klug Alexander, Sauter Matthias, Hoffmann Reinhard

机构信息

BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt, Deutschland.

出版信息

Unfallchirurgie (Heidelb). 2023 Sep;126(9):679-686. doi: 10.1007/s00113-023-01321-0. Epub 2023 Apr 28.

DOI:10.1007/s00113-023-01321-0
PMID:37115205
Abstract

The complex injury pattern of a posterior elbow dislocation with concomitant radial head and coronoid fractures is usually referred to as a terrible triad injury. Due to the concomitant compromise of several osteoligamentous structures of the elbow joint relevant for stability, these injuries pose a particularly major challenge to the treating trauma surgeons. For this reason, a careful preoperative analysis of all relevant injury components is mandatory in order to make an adequate treatment decision. In most cases, surgical treatment addressing all elements relevant for stability is necessary to achieve a stable and congruent elbow joint. Only this enables early functional follow-up treatment and minimizes the complication rate. Delayed or even insufficient treatment with persistent (sub)dislocation must be avoided at all costs, otherwise there is a high risk of serious posttraumatic functional disorders of the elbow with rapid progression of osteoarthritis.

摘要

伴有桡骨头和冠突骨折的肘关节后脱位的复杂损伤模式通常被称为可怕三联征损伤。由于肘关节几个与稳定性相关的骨韧带结构同时受损,这些损伤给创伤外科医生带来了特别大的挑战。因此,必须对所有相关损伤成分进行仔细的术前分析,以便做出适当的治疗决策。在大多数情况下,针对所有与稳定性相关的因素进行手术治疗对于实现稳定且关节面一致的肘关节是必要的。只有这样才能进行早期功能随访治疗并将并发症发生率降至最低。必须不惜一切代价避免延迟治疗甚至治疗不足导致持续性(亚)脱位,否则肘关节严重创伤后功能障碍并迅速发展为骨关节炎的风险很高。

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本文引用的文献

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Current concepts in elbow fracture dislocation.肘关节骨折脱位的当前概念
Shoulder Elbow. 2021 Aug;13(4):451-458. doi: 10.1177/1758573219884010. Epub 2019 Nov 13.
2
Surgical treatment of the radial head is crucial for the outcome in terrible triad injuries of the elbow.对于肘部严重三联征损伤,桡骨头的手术治疗对于结果至关重要。
Bone Joint J. 2020 Dec;102-B(12):1620-1628. doi: 10.1302/0301-620X.102B12.BJJ-2020-0762.R1.
3
Epidemiology and Treatment of Radial Head Fractures: A Database Analysis of Over 70,000 Inpatient Cases.
桡骨头骨折的流行病学和治疗:超过 70000 例住院病例的数据库分析。
J Hand Surg Am. 2021 Jan;46(1):27-35. doi: 10.1016/j.jhsa.2020.05.029. Epub 2020 Aug 11.
4
What Factors Are Associated with Reoperation After Operative Treatment of Terrible Triad Injuries?哪些因素与三联征损伤手术后再次手术有关?
Clin Orthop Relat Res. 2021 Jan 1;479(1):119-125. doi: 10.1097/CORR.0000000000001391.
5
Biomechanical Functional Elbow Restoration of Acute Ulnar Collateral Ligament Tears: The Role of Internal Bracing on Gap Formation and Repair Stabilization.急性尺侧副韧带撕裂的生物力学功能肘修复:内支撑在间隙形成和修复稳定中的作用。
Am J Sports Med. 2020 Jul;48(8):1884-1892. doi: 10.1177/0363546520921174. Epub 2020 May 26.
6
Comparison of bipolar and monopolar radial head prostheses in elbow fracture-dislocation.桡骨头双极和单极假体治疗肘关节骨折脱位的比较。
Orthop Traumatol Surg Res. 2020 Apr;106(2):311-317. doi: 10.1016/j.otsr.2019.10.027. Epub 2020 Mar 12.
7
Anterior capsule re-attachment in terrible triad elbow injury with coronoid tip fracture.前关节囊再附着治疗伴有冠状突尖骨折的三联征肘损伤。
Orthop Traumatol Surg Res. 2019 Dec;105(8):1575-1583. doi: 10.1016/j.otsr.2019.09.024. Epub 2019 Nov 12.
8
High Risk of Further Surgery After Radial Head Replacement for Unstable Fractures: Longer-term Outcomes at a Minimum Follow-up of 8 Years.桡骨头置换术后不稳定骨折再次手术风险高:至少 8 年的长期随访结果。
Clin Orthop Relat Res. 2019 Nov;477(11):2531-2540. doi: 10.1097/CORR.0000000000000876.
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Clin Orthop Relat Res. 2019 Nov;477(11):2541-2543. doi: 10.1097/CORR.0000000000000913.
10
Radial head replacement versus reconstruction for the treatment of the terrible triad injury of the elbow: a systematic review and meta-analysis.桡骨头置换与重建治疗肘关节恐怖三联征:一项系统评价和Meta分析
Arch Orthop Trauma Surg. 2019 Apr;139(4):507-517. doi: 10.1007/s00402-019-03111-z. Epub 2019 Jan 17.