探讨手术治疗肘关节恐怖三联征的临床效果。

回顾性分析2011年5月至2016年9月在惠州市中心人民医院行手术治疗的肘关节恐怖三联征患者25例，所有患者均明确高空坠落、车祸伤等高能量损伤外伤史，X线片及CT检查肘关节脱位，合并桡骨小头骨折及尺骨冠状突骨折且选择手术治疗。排除存在较为严重的复合伤、多发骨折，或合并类风湿性肘关节炎、系统性红斑狼疮、良恶性骨肿瘤患者，合并脊髓损伤影响上肢功能者患者，依从性较差患者和中途退出本研究患者。其中男20例，女5例，手术时年龄平均(35±11)岁。采用Mayo评分以及Broberg-Morrey评分评估患者术后肘关节功能。采用配对样本t检验及Fisher确切概率法。

截止至2018年3月末次随访时，所有患者肘关节骨折部位均已愈合，平均愈合时间(16±5)周。术前患者前臂旋转活动度为(73±9)°，术后前臂旋转活动度为(121±8)°，差异具有统计学意义(t＝21.619，P<0.01)，术前肘关节屈伸活动度为(63±8)°，术后肘关节屈伸活动度为(108±10)°，差异具有统计学意义(t＝17.879，P<0.01)。肘关节Mayo评分：优14例，良5例，可4例，差2例，优良率为76 %；Broberg-Morrey肘关节功能评分：优12例，良8例，可3例，差2例，优良率为80%。手术时机<3 d、3～14 d、>14 d的患者术后肘关节功能优良率分别为94%、60%、25%(P＝0.011)；冠状突骨折Ⅰ、Ⅱ、Ⅲ型的患者术后肘关节功能优良率分别为94%、50%、45%(P＝0.016)，桡骨小头骨折Ⅰ、Ⅱ、Ⅲ型的患者术后肘关节功能优良率分别为94%、40%、33%，差异均有统计学意义(P＝0.006)；内外侧联合入路、单纯肘关节外侧入路的患者术后肘关节功能优良率分别为89%、43%(P＝0.032)；制动时间<2周、2～4周、>4周的患者术后肘关节功能优良率分别为93%、67%、25%(P＝0.013)。

手术治疗是肘关节恐怖三联征的重要治疗手段，术后肘关节功能的恢复与手术时机、冠状突及桡骨小头骨折类型、手术入路、制动时间等因素密切相关。

To explore the results of terrible triad of the elbow treated with surgical intervention.

This retrospective study included 25 cases of elbow joint triad of patients undergoing surgery in Huizhou Center People’s Hospital from May 2011 to September 2016. All the patients were identified with high-energy injury and traumatic history such as high fall and car accident injury. X-ray and CT examination of elbow dislocation, combined with radial head fracture and ulnar coronoid process fracture and surgical treatment. Patients who combined with serious combined injuries, shock, multiple fracture, rheumatoid elbow arthritis, lupus erythematosus, benign and malignant bone tumors, spinal cord injury affecting upper limb function, with poor compliance and withdrawal from the study were excluded. The mean age of patients at surgery was (35±10) years in 20 men and five women. The Mayo score and the Broberg-Morrey score were used to evaluate the elbow function postoperatively. Paired-t test and Fisher exact probability method was used.

At the last follow-up in March 2018, all the fractures healed at (16±5) weeks. The range of rotation of the forearm was (73±9)° preoperatively and (121±8)° postoperatively (t=21.619, P<0.001). The range of motion of the elbow joint was (63±8)° before surgery and (108±10)° postoperatively (t=17.879, P<0.001). According to Mayo score of elbow joint, there were 14 cases of excellent, five cases of good, four cases of fair and two poor cases, excellent and good rate was 76%. According to Broberg-Morrey elbow joint function score, there were excellent in 12 cases, good in eight cases, fair in three cases and poor in two cases, the excellent and good rate was 80%. The excellent and good rate of elbow joint function of patients with operation time <3 d, 3-14 d, >14 d were 98%, 60%, 25%, respectively (P=0.011). The excellent and good rate of elbow joint function in patients with ulna coracoid process fracture of type I, II and III were 94%, 50% and 45%, respectively (P=0.016). The excellent and good rate of postoperative elbow joint function in patients with type I, II and III of capitulum radial fracture were 94%, 40%, 33% (P=0.006). The excellent and good rate of elbow joint function in patients with internal and external combined approach and simple lateral elbow approach was 89%, 43% respectively (P=0.032). The excellent and good elbow joint function of patients with braking time less than two weeks, between two and four weeks, more than four weeks were 93%, 67%, 25%, respectively (P=0.013).

Surgical treatment is important for terrible triad of the elbow, the postoperative recovery of elbow function is closely related to the average time of injury to surgery, the fracture type of the radial head and coronoid process, the surgical approach and the in mobilzation time.