Le Gia Anh Thy, To Kha, Dang Nghia Thanh, Nguyen Viet Tan, Phan Tri Nguyen, Nguyen Van Thai, Ton Thi Thanh Thao, Vo Thanh Toan
Department of Upper Limbs, Hospital for Traumatology and Orthopaedics, Ho Chi Minh City.
School of Medicine, Vietnam National University Ho Chi Minh City.
Ann Med Surg (Lond). 2024 Jun 20;86(8):4352-4357. doi: 10.1097/MS9.0000000000002211. eCollection 2024 Aug.
Standard surgical management for the terrible triad of the elbow (TTE) has been established since 2004, yet postoperative complications are common and consensus on optimal management is absent. Different surgical algorithms for treating TTE and their efficacy have been reported worldwide, yet evidence from Vietnam remains limited.
Ten cases diagnosed with TTE admitted to the Hospital of Traumatology and Orthopedics, a tertiary orthopedic center in Ho Chi Minh City, were presented to demonstrate the effectiveness and rate of postoperative complications following our stepwise surgical procedures using the anconeus-triceps lateral flap approach. The intraoperative "drop sign", quantitative assessment of pain and level of upper arm disability (via VAS and QuickDASH score) was mentioned to assess the algorithm's benefit. All patients' information was retrieved from medical records from August 2022 to January 2024.
All 10 cases required repair of the lateral ligament complex and underwent surgery within 2 days of hospitalization. Immediate postoperative imaging revealed no drop sign, and none of the patients experienced elbow dislocation nor the need for repeated surgery, and a full range of elbow motion was demonstrated at 3-6 months follow-up.
TTE is a challenging injury that almost always obligates surgical correction. The anconeus-triceps lateral flap approach, with its advantages of better visualization and preservation of certain essential stabilizing muscles of the elbow, was demonstrated to yield a high success rate and low postoperative complication rate.
自2004年以来，肘部可怕三联征（TTE）的标准手术管理方法已确立，但术后并发症很常见，且对于最佳管理方法尚无共识。世界各地都报道了治疗TTE的不同手术方案及其疗效，但来自越南的证据仍然有限。
介绍了胡志明市一家三级骨科中心——创伤与矫形医院收治的10例诊断为TTE的病例，以展示我们采用肱三头肌外侧皮瓣入路的分步手术方法术后的有效性和并发症发生率。提到术中“下垂征”、疼痛的定量评估以及上臂残疾程度（通过视觉模拟评分法和快速DASH评分）来评估该手术方案的益处。所有患者的信息均从2022年8月至2024年1月的病历中获取。
所有10例患者均需要修复外侧韧带复合体，并在住院2天内接受了手术。术后即刻影像学检查未发现下垂征，所有患者均未发生肘关节脱位，也无需再次手术，在3至6个月的随访中显示肘关节活动范围正常。
TTE是一种具有挑战性的损伤，几乎总是需要手术矫正。肱三头肌外侧皮瓣入路具有更好的视野以及保留肘部某些重要稳定肌肉的优点，被证明具有较高的成功率和较低的术后并发症发生率。
