目的总结采用一个切口两个入路的方法治疗肘关节三联征的临床效果。方法2011 年 1 月—2016 年 1 月,收治肘关节三联征患者 13 例。男 10 例,女 3 例;年龄 21~55 岁,平均 35 岁。致伤原因:摔伤 8 例,高处坠落伤 5 例;均为闭合性骨折。桡骨头骨折按 Mason 分型,Ⅱ型 7 例,Ⅲ型 6 例;尺骨冠状突骨折按 O’Driscoll 分型,均为尖部骨折,第一亚型 2 例,第二亚型 11 例。伤后至手术时间 7~21 d,平均 12 d。采用肘部前外侧切口,将皮瓣分别向前、后掀起,经前路和外侧入路分别修复冠状突、桡骨头和外侧副韧带。结果患者手术伤口均Ⅰ期愈合。13 例患者均获随访,随访时间 6~12 个月,平均 9 个月。无桡神经损伤、感染、迟发性尺神经炎、复发性不稳定、疼痛及内固定物松动等并发症发生,切口无瘢痕挛缩。X 线片示骨折均愈合,愈合时间 3~8 个月,平均 5.6 个月。肘关节稳定性良好,无复发性脱位;4 例患者 X 线片示有轻度异位骨化征象,但不影响肘关节功能。末次随访时根据 Mayo 肘关节功能评分标准进行评价,获优 8 例,良 2 例,可 3 例,优良率 76.9%。结论采用一个切口两个入路方法治疗肘关节三联征,骨折固定牢固可靠,患者早期即能进行功能锻炼,肘关节稳定性良好,是一种有效可行的治疗方式。
Citation:
杨颇, 赵明宇, 宋开芳, 周家顺, 陶磊, 金鑫, 严芳, 何宣林. 一个切口两个入路治疗肘关节三联征疗效观察. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(7): 890-892. doi: 10.7507/1002-1892.201701059
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Reichel LM, Milam GS, Reitman CA. Anterior approach for operative fixation of coronoid fractures in complex elbow instability. Tech Hand Up Extrem Surg, 2012, 16(2): 98-104.
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- 1. Hotchkiss RN. Fractures and dislocations of the elbow. Rockwood and Green’s fractures in adults. 4th eds. Philadelphia: Lippincott-Raven, 1996: 929-1024.
- 2. Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg, 1954, 42(172): 123-132.
- 3. O’Driscoll SW, Jupiter JB, Cohen MS. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect, 2003, 52: 113-134.
- 4. Yoon A, Athwal GS, Faber KJ, et al. Radial head fractures. J Hand Surg (Am), 2012, 37(17): 2626-2634.
- 5. 张友, 刘世清, 周宏斌. 肘关节恐怖三联征改良分型标准及治疗探讨. 中国修复重建外科杂志, 2016, 30(3): 353-358.
- 6. 马宁, 于涛, 袁锋. 肘关节恐怖三联征的治疗进展. 中国修复重建外科杂志, 2013, 27(4): 496-499.
- 7. Reichel LM, Milam GS, Reitman CA. Anterior approach for operative fixation of coronoid fractures in complex elbow instability. Tech Hand Up Extrem Surg, 2012, 16(2): 98-104.
- 8. Ring D, Gulotta L, Chin K, et al. Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus. J Orthop Trauma, 2004, 18(7): 446-449.