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Title: [Short-term effectiveness of free radial head reconstruction of coronoid process combined with artificial radial head replacement in treatment of complex terrible triad of elbow].
Author: Chen T, Ma X, Ma J, Yu R, Yu D.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2021 Feb 15; 35(2):139-143. PubMed ID: 33624463.
Abstract:
OBJECTIVE: To investigate the short-term effectiveness of free radial head reconstruction of coronoid process, artificial radial head replacement, and ulna olecranon internal fixation in the treatment of the complex terrible triad of the elbow. METHODS: Retrospective analysis was made on the clinical data of 12 patients with complex terrible triad of the elbow treated with free radial head reconstruction of coronoid process, artificial radial head replacement, and ulna olecranon internal fixation between April 2011 and April 2018. There were 8 males and 4 females with an average age of 44.5 years (range, 26-62 years). The causes of injury included 5 cases of traffic accident, 7 cases of falling from hight. The Regan-Morrey classification of ulnar coronoid process fractures was type Ⅲ; Mason classification of radial head fractures was type Ⅲ in 7 cases and type Ⅳ in 5 cases. The time from injury to operation was 5-14 days, with an average of 6.0 days. The operation time, intraoperative blood loss, and complications were recorded. After operation, X-ray film of elbow joint was reexamined, fracture healing condition was observed, and fracture healing time was recorded. The flexion, extension, and rotation of the elbow joints on the healthy and affected sides were recorded and measured. The elbow function was evaluated according to Mayo elbow function score. RESULTS: The operation time was 90-140 minutes (mean, 110 minutes); the intraoperative blood loss was 100-300 mL (mean, 150 mL). None of the patients had vascular injury during the operation. One patient developed numbness in the ulnar nerve innervation area and recovered completely after symptomatic treatment for 1 week. All the 12 patients were followed up 12-22 months, with an average of 16 months. At last follow-up, the fracture healed completely, 1 patient developed ectopic ossification of elbow joint, and 2 patients developed traumatic arthritis of elbow joint. No internal fixation-related complications occurred. There was no significant difference in the range of motion of elbow flexion, extension, pronation, and supination between the affected and healthy sides ( P>0.05). The median Mayo elbow function score was 96, and the interquartile range was (94, 97), and the excellent and good rate was 91.7%. CONCLUSION: For patients with complex terrible triad of the elbow with ulna coronoid process fractures of Regan-Morrey type Ⅲ and radial head fractures of Mason type Ⅲ, Ⅳ combined with ulna olecranon fractures, the free radial head reconstruction, artificial radial head replacement, and ulna olecranon internal fixation, through active rehabilitation function exercise after operation, can achieve more satisfactory short-term effectiveness. 目的: 探讨使用游离桡骨头重建冠状突、人工桡骨头置换、尺骨鹰嘴内固定治疗复杂肘关节恐怖三联征的早期疗效。. 方法: 回顾分析 2011 年 4 月—2018 年 4 月使用游离桡骨头重建冠状突、人工桡骨头置换、尺骨鹰嘴内固定治疗的 12 例复杂肘关节恐怖三联征患者临床资料。男 8 例，女 4 例；年龄 26～62 岁，平均 44.5 岁。致伤原因：交通事故伤 5 例，高处坠落伤 7 例。所有患者尺骨冠状突骨折 Regan-Morrey 分型均为 Ⅲ 型；桡骨头骨折 Mason 分型 Ⅲ 型 7 例，Ⅳ型 5 例。受伤至手术时间 5～14 d，平均 6.0 d。记录患者手术时间、术中出血量及并发症发生情况。术后复查肘关节 X 线片，观察骨折愈合情况，记录骨折愈合时间；测量并记录健、患侧肘关节屈伸及旋转活动度，根据 Mayo 肘关节功能评分评价肘关节功能。. 结果: 手术时间 90～140 min，平均 110 min；术中出血量 100～300 mL，平均 150 mL。患者术中均无血管损伤；1 例出现尺神经支配区麻木，予以对症治疗 1 周后完全恢复。12 例均获随访，随访时间 12～22 个月，平均 16 个月。末次随访时骨折均完全愈合，1 例出现肘关节异位骨化，2 例出现肘关节创伤性关节炎；均无内固定相关并发症发生。患肢屈肘、伸肘、旋前、旋后活动度与健侧比较差异均无统计学意义（ P>0.05）。Mayo 肘关节功能评分中位数为 96 分，四分位数间距为（94，97）分，优良率为 91.7%。. 结论: 对于尺骨冠状突骨折 Regan-MorreyⅢ 型，桡骨头骨折 MasonⅢ、Ⅳ 型合并尺骨鹰嘴骨折的复杂肘关节恐怖三联征患者，使用游离桡骨头重建冠状突、人工桡骨头置换、尺骨鹰嘴内固定治疗，术后通过积极的康复功能锻炼，可取得较满意早期临床疗效。.

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