摘要目的 探讨前侧入路为主、外侧入路为辅并经内固定加软组织修复治疗肘关节损伤三联征的方法和临床疗效. 方法 回顾性分析2011年1月-2014年8月治疗15例肘关节损伤三联征患者的临床资料,其中男10例,女5例;年龄20 ～61岁,平均38.4岁.致伤原因:交通伤9例,高处坠落伤3例,摔伤3例.桡骨头骨折按Mason分型:Ⅰ型5例,Ⅱ型8例,Ⅲ型2例;尺骨冠状突骨折按Regan-Morrey分型:Ⅰ型4例,Ⅱ型10例,Ⅲ型1例.受伤至手术时间平均为8.5d.所有患者先经肘前侧人路,冠状突骨折用Herbert螺钉固定,或经骨隧道套索缝合前侧关节囊固定,桡骨头骨折予Herbert螺钉固定,再经肘外侧切口,予铆钉或经肱骨外上髁钻孔,2-0爱惜邦缝线编织缝合,修复外侧韧带复合体和伸肌总腱.应用肘关节屈伸度、前臂旋转活动度及Mayo肘关节功能评分(MEPS)评估临床疗效功能,并观察并发症发生情况. 结果 患者均获得随访12 ～ 30个月,平均19.6个月.冠状突骨折均愈合,14例桡骨头骨折获得骨愈合.术前与末次随访时肘关节屈伸度[(45.1±5.6)°:(129.5±9.3)°]、前臂旋转活动度[(55.4±8.7)°:(140.5±10.3)°]及MEPS评分[(25.1±9.6)分:(91.2±5.2)分]比较差异均有统计学意义(P＜0.01).并发症包括异位骨化1例、桡骨头骨折不愈合1例,无肘部血管神经损伤、肘关节不稳、脱位、肘关节僵硬或疼痛. 结论 以经前侧入路为主联合外侧入路,采取内固定加软组织修复治疗肘关节损伤三联征,可有效恢复肘关节功能.

abstractsObjective To discuss the surgical techniques and results of internal fixation supplemented with soft tissue repair of triad injury of the elbow via the combined anterior-lateral approach.Methods A retrospective analysis was done on 15 patients with triad injury of the elbow treated from January 2011 to August 2014.There were 10 males and 5 females,aged 38.4 years (range,20-61 years).Injury resulted from traffic accidents in nine patients,high-level falls in three and groundlevel falls in three.Radial head fractures were Mason type Ⅰ in five patients,type Ⅱ in eight,and type Ⅲ in two.Fractures of the coronoid process of the ulna were Regan-Morrey type Ⅰ in four patients,type Ⅱ in ten and type Ⅲ in one.Time interval between injury and operation was 8.5 d.All patients were firstly operated on through the anterior approach to have Herbert screw fixation or anterior capsule suture lasso fixation of the coronoid fracture as well as Herbert screw fixation of the radial head fracture.And then,elbow lateral incision was made to repair lateral collateral ligament complex and common extensor tendon by 2-0 Ethibon suture.Elbow flexion-extension,forearm pronation-supination and Mayo elbow performance score (MEPS) were used to evaluate the clinical elbow functions.Complications were recorded after operation.Results All patients were followed up for mean 19.6 months (range,12-30 months).All coronoid fractures healed.Radial head fractures in 14 patients healed.Comparison of preoperative to final follow-up variables presented significant differences in elbow flexion-extension [(45.1 ± 5.6) °:(129.5 ± 9.3) °],forearm pronation-supination [(55.4 ±.8.7) °:(140.5 ± 10.3) °] and MEPS [(25.1 ± 9.6) points:(91.2 ± 5.2) points] (P ＜ 0.01).Complications included heterotopic ossification in one patient and nonunion of radial head fracture in one patient.No neurovascular injury of the elbow,elbow residual instability,dislocation,elbow stiffness and active pain occurred.Conclusion Combined anterior-lateral approach with internal fixation and soft tissue repair is a simple and safe method that effectively restore the elbow joint function.