Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, NO. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi Province, China.
Sci Rep. 2023 Jul 19;13(1):11656. doi: 10.1038/s41598-023-38885-1.
The treatment of ulna coronal process fractures in the terrible triad of elbow, especially type I and II Regan-Morrey coronoid fractures, still have been controversial. The purpose of this retrospective study was to evaluate the novel Lasso-plate technique to have a more reliable fixation and a well clinical outcomes for type I and II Regan-Morrey coronoid fractures in a terrible triad of the elbow (TTE). Patients with simple TTE, closed fracture, aged > 18 years, duration of injury < 2 weeks, type I and II Regan-Morrey coronoid process fracture fixed by the Lasso-plate technique or ORIF were enrolled in the study. Total 144 patients with type I and II Regan-Morrey coronoid fracture in TTE were included in the Lasso-plate group or ORIF (open reduction and internal fixation) group in the Xi'an Honghui Hospital from January 2017 to December 2020. Eighty-six patients in Lasso-plate group underwent surgery using a novel Lasso-plate technique. And other 58 patients in ORIF group underwent surgery using ORIF. The data of two groups, including the X-ray films, Computed tomography (CT), the range of elbow motion, Mayo Elbow Performance Score (MEPS) and the surgical complications, were extracted from the hospital's patient records. All patients in both groups were followed up at least 12 months. The mean operation time (88.2 ± 12.3 min) in Lasso-plate group is shorter than that of ORIF group (109.1 ± 13.0 min). There was one patient with injury of deep branch of radial nerve and one patient with superficial surgical incision infection in Lasso-plate group. There were two patients with surgical incision infection in ORIF group. There were three heterotopic ossifications in Lasso-plate group and eight heterotopic ossifications in ORIF group. There were 5 elbow joints stiffness in Lasso-plate group and 12 in ORIF group. At 12 months follow up, the mean range of flexion-extension motion in Lasso-plate group was 122.9° ± 13.4° versus 113.2° ± 18.1° in ORIF group (p < 0.01), the mean 89.7 ± 5.6 MEPS in Lasso-plate group versus mean 83.7 ± 6.1 MEPSin ORIF group. The fixation of coronoid process fracture in TTE by the Lasso-plate technique, especially type I and II Regan-Morrey coronoid fracture, could be easier to master and operate, could provide the sufficient stability of elbow joint to enable early functional exercise, along with a better clinical outcome, a lower surgical complication. For the treatment of TTE, we recommend the fixation of type I and II Regan-Morrey coronoid fracture with the Lasso-plate technique, which would result in a better clinical outcome.
在肘部三联征（TTE）中，尤其是Ⅰ型和Ⅱ型 Regan-Morrey 冠状突骨折的尺骨冠状突骨折的治疗仍存在争议。本回顾性研究的目的是评估新型 Lasso 钢板技术对于 TTE 中Ⅰ型和Ⅱ型 Regan-Morrey 冠状突骨折的更可靠固定和更好的临床结果。
研究纳入了单纯 TTE、闭合性骨折、年龄>18 岁、受伤时间<2 周、Ⅰ型和Ⅱ型 Regan-Morrey 冠状突骨折采用 Lasso 钢板技术或切开复位内固定（ORIF）治疗的患者。
2017 年 1 月至 2020 年 12 月，西安红会医院收治了 144 例 TTE 中Ⅰ型和Ⅱ型 Regan-Morrey 冠状突骨折患者，其中 86 例采用新型 Lasso 钢板技术治疗，58 例采用 ORIF 治疗。从医院病历中提取两组患者的 X 线片、计算机断层扫描（CT）、肘运动范围、Mayo 肘功能评分（MEPS）和手术并发症等数据。所有患者均至少随访 12 个月。
Lasso 钢板组的平均手术时间（88.2±12.3min）短于 ORIF 组（109.1±13.0min）。Lasso 钢板组有 1 例桡神经深支损伤，1 例浅表手术切口感染；ORIF 组有 2 例手术切口感染。Lasso 钢板组有 3 例异位骨化，ORIF 组有 8 例异位骨化。Lasso 钢板组有 5 例肘关节僵硬，ORIF 组有 12 例。
12 个月随访时，Lasso 钢板组的平均屈伸运动范围为 122.9°±13.4°，ORIF 组为 113.2°±18.1°（p<0.01）；Lasso 钢板组的平均 MEPS 为 89.7±5.6，ORIF 组为 83.7±6.1。
Lasso 钢板技术治疗 TTE 中的冠状突骨折，特别是Ⅰ型和Ⅱ型 Regan-Morrey 冠状突骨折，更容易掌握和操作，可以为肘关节提供足够的稳定性，使患者能够早期进行功能锻炼，并获得更好的临床结果和更低的手术并发症。对于 TTE 的治疗，我们建议采用 Lasso 钢板技术固定Ⅰ型和Ⅱ型 Regan-Morrey 冠状突骨折，以获得更好的临床结果。
