目的 肘关节恐怖三联征除了X片可见的后脱位和桡骨头及尺骨冠突骨折外, 还有广泛的软组织损害。本文根据肘关节内侧副韧带(MCL)损伤如否, 将肘关节恐怖三联征分为2个亚型并探讨其临床意义。方法 2004—2009年, 共治疗7例肘关节恐怖三联征, 其中Ⅰ型2例(MCL完整)保守治疗, 石膏固定2~3周后功能锻炼;Ⅱ型5例(MCL断裂)手术治疗, 经内外侧双切口显露, 分别固定桡骨头和冠突, 修复外侧副韧带和内侧副韧带。结果 7例患者获得1~4年随访(平均2年)。骨折愈合, 肘关节稳定, 活动无疼痛。活动幅度屈伸平均120°, 旋转100°, MEPS评分优5例, 良2例。结论 在肘关节恐怖三联征中, MCL完整者, 其桡骨头和冠突骨折的类型和移位均较轻, 可保守治疗;MCL断裂者, 其骨折类型和移位均较重, 需手术治疗。修复MCL能显著提高肘关节的稳定性。
Objective Besides radial head and coronoid fractures,terrible triad injury of the elbow involves a wide range of soft-tissue ruptures.The paper proposes a classification of the terrible triad injury with special reference to the status of medial collateral ligament (MCL).Methods From 2004 to 2009,seven patients with terrible triad injury were treated consecutively.There were 2 in type Ⅰ (MCL-intact) managed conservatively and 5 in type Ⅱ (MCL-ruptured) managed surgically.The operation involved lateral and medial double approaches.The fractures were screw or suture fixed.The lateral collateral ligament (LCL) was repaired by sutures through drilled holes or bone anchors.The elbow was not concentric reduced during intraoperative forearm weight test,and then the MCL was further repaired.Results All 7 patients were followed up for 1-4 years (average 2 years),with healed fracture,stable elbow and no pain movement.The average range of motion was 120 degrees in flexion-extension,100 degrees in pronation-supination.The functional outcome was excellent in 5 and good in 2 according to Mayo Elbow Performance Score.Conclusion Terrible triad injury with MCL-intact was related with minor radial head and coronoid fractures and displacement and may be managed conservatively,while with MCL-ruptured,relevant to major fractures and displacement,and should be treated surgically.Further MCL repair enhances the stability greatly in terrible triad of the elbow.
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