摘要目的 报告应用侧副韧带修补重建并桡骨小头切除手术方式治疗青年肘关节恐怖三联征、桡骨小头粉碎骨折患者的疗效观察.方法 自2005年11月至2009年10月,本院共收治肘关节三联征损伤3例.桡骨小头骨折按Mason法分类均为Ⅲ型.3例患者均行冠状突固定、肘内外侧副韧带、关节囊修补、内侧副韧带加强、重建并桡骨小头切除术,术后克氏针辅助固定肱尺关节于屈肘90°前臂旋转中立位,石膏固定3周,然后拔除克氏针,去除石膏,开始屈伸和旋转康复训练.结果 3例患者均随访1年以上,骨折愈合,按照Broberg和Morrey的肘关节功能评分2例为良,1例为可.结论 肘关节恐怖三联征伴有桡骨小头粉碎骨折的青年患者,韧带及关节囊的重建异常重要,桡骨小头置换应当审慎,在确保韧带重建满意的情况下切除桡骨小头并未造成肘关节明显功能障碍.

abstractsObjective To observe the results of medial collateral ligament reconstruction plus radial head resection in the treatment of terrible triad of the elbow for young patients. Methods From November 2005 to October 2009,3 cases of terrible triad of the elbow were treated in our hospital. The radial head fractures were classified in type Ⅲ according to Mason classification. All patients underwent coronoid fixation, collateral ligament and joint capsule repair, medial collateral ligament reconstruction and radial head resection. Postoperatively Kirschner wire and the plaster was applied for elbow stabilization for 3 weeks after operation, in position with elbow flexion in 90 degrees and forearm rotation in neutral, and then removal of Kirschner wire and the plaster. Then physical exercise and rehabilitation program were carried out. Results 3 patients were followed up for more than 1 year with fracture healing. The functional outcome in 3 cases was excellent in 2 and good in 1 according to Broberg and Morrey Elbow Score. Conclusion It is exceptionally important of the reconstruction of collateral ligaments and joint capsule in the treatment of elbow terrible triad associated with radial head comminuted fracture for young patients. Radial head replacement should be cautious. Radial head resection under the premise of satisfactory ligament reconstruction does not cause significant elbow dysfunction.