肘關節恐怖三聯征的治療進展_《中國修復重建外科雜志》

作者：

馬寧 , 于濤 , 袁鋒

同濟大學附屬同濟醫院骨科（上海，200065）;

關鍵詞：

肘關節恐怖三聯征骨折固定韌帶修復治療進展

DOI：

10.7507/1002-1892.20130112

視頻：

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目的總結肘關節恐怖三聯征的損傷機制及治療進展，分析進一步研究方向。方法查閱近年國內外有關肘關節恐怖三聯征研究的相關文獻，并進行綜合分析。結果肘關節恐怖三聯征的治療方式以手術為主，治療目的是重建肘關節的穩定性。手術方法主要包括縫合固定或螺釘、鋼板固定冠突，螺釘、鋼板固定橈骨頭或對橈骨頭進行部分或全部置換，經骨縫合或錨釘固定外側副韌帶及內側副韌帶以及外固定架的應用。這些手術方法各有其適應證及優點，多數獲得滿意療效。結論肘關節恐怖三聯征一般需行手術治療以恢復肘關節穩定性，但內側韌帶修復與否、入路的選擇以及損傷機制仍需進一步研究。

引用本文： 馬寧,于濤,袁鋒. 肘關節恐怖三聯征的治療進展. 中國修復重建外科雜志, 2013, 27(4): 496-499. doi: 10.7507/1002-1892.20130112 復制

1.	Bucholz RW, Heckman JD, Court-Brown CM. Rockwood & Green’s Fractures in Adults. 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2010: 906-946.
2.	Mehta JA, Bain GI. Posterolateral rotatory instability of the elbow. J Am Acad Orthop Surg, 2004, 12(6): 405-415.
3.	Fitzpatrick MJ, Diltz M, McGarry MH, et al. A new fracture model for “terrible triad” injuries of the elbow: influence of forearm rotation on injury patterns. J Orthop Trauma, 2012, 26(10): 591-596.
4.	Guitton TG, Ring D. Nonsurgically treated terrible triad injuries of the elbow: report of four cases. J Hand Surg (Am), 2010, 35(3): 464-467.
5.	Mathew PK, Athwal GS, King GJ. Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg, 2009, 17(3): 137-151.
6.	Cheung EV, Steinmann SP. Surgical approaches to the elbow. J Am Acad Orthop Surg, 2009, 17(5): 325-333.
7.	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.
8.	Garrigues GE, Wray WH 3rd, Lindenhovius AL, et al. Fixation of the coronoid process in elbow fracture-dislocations. J Bone Joint Surg (Am), 2011, 93(20): 1873-1881.
9.	匡新建, 蔡航, 鮑豐, 等. 肘關節恐怖三聯征的手術治療. 中國修復重建外科雜志, 2011, 25(8): 964-967.
10.	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.
11.	Pai V, Pai V. Use of suture anchors for coronoid fractures in the terrible triad of the elbow. J Orthop Surg (Hong Kong), 2009, 17(1): 31-35.
12.	匡新建, 蔡航, 鮑豐, 等. 微型鋼板治療尺骨冠狀突骨折. 中國修復重建外科雜志, 2010, 24(9): 1097-1099.
13.	Ring D, Guss D, Jupiter JB. Reconstruction of the coronoid process using a fragment of discarded radial head. J Hand Surg (Am), 2012, 37(3): 570-574.
14.	Leigh WB, Ball CM. Radial head reconstruction versus replacement in the treatment of terrible triad injuries of the elbow. J Shoulder Elbow Surg, 2012, 21(10): 1336-1341.
15.	Turner RG, Rispoli D, Lopez-Gonzalez FM, et al. Partial allograft replacement of the radial head in the management of complex fracture-dislocations of the elbow. J Shoulder Elbow Surg, 2012, 21(3): 396-404.
16.	Pugh DM, Wild LM, Schemitsch EH, et al. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg (Am), 2004, 86-A(6): 1122-1130.
17.	Ring D, Hannouche D, Jupiter JB. Surgical treatment of persistent dislocation or subluxation of the ulnohumeral joint after fracture-dislocation of the elbow. J Hand Surg (Am), 2004, 29(3): 470-480.
18.	Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg (Am), 2002, 84-A(4): 547-551.
19.	Forthman C, Henket M, Ring DC. Elbow dislocation with intra-articular fracture: the results of operative treatment without repair of the medial collateral ligament. J Hand Surg (Am), 2007, 32(8): 1200-1209.
20.	Rodriguez-Martin J, Pretell-Mazzini J, Andres-Esteban EM, et al. Outcomes after terrible triads of the elbow treated with the current surgical protocols. A review. Int Orthop, 2011, 35(6): 851-860.
21.	陳碩, 黃富國, 胡曉川, 等. 肘關節“恐怖三聯征”的手術治療. 中國修復重建外科雜志, 2009, 23(1): 45-48.
22.	Jeong WK, Oh JK, Hwang JH, et al. Results of terrible triads in the elbow: the advantage of primary restoration of medial structure. J Orthop Sci, 2010, 15(5): 612-619.
23.	張世民, 俞光榮, 袁鋒, 等. 肘關節后脫位伴橈骨頭和尺骨冠突骨折(恐怖三聯征)5例初步報告. 中國矯形外科雜志, 2007, 15(14): 1069-1073.
24.	Toros T, Ozaksar K, Sugun TS, et al. The effect of medial side repair in terrible triad injury of the elbow. Acta Orthop Traumatol Turc, 2012, 46(2): 96-101.
25.	Chemama B, Bonnevialle N, Peter O, et al. Terrible triad injury of the elbow: how to improve outcomes. Orthop Traumatol Surg Res, 2010, 96(2): 147-154.
26.	Rhyou IH, Kim YS. New mechanism of the posterior elbow dislocation. Knee Surg Sports Traumatol Arthrosc, 2012, 20(12): 2535-2541.
27.	Chen NC, Julka A. Hinged external fixation of the elbow. Hand Clin, 2010, 26(3): 423-433, vii.
28.	Volkov MV, Oganesian OV. Restoration of function in the knee and elbow with a hinge-distractor apparatus. J Bone Joint Surg (Am), 1975, 57(5): 591-600.

1. Bucholz RW, Heckman JD, Court-Brown CM. Rockwood & Green’s Fractures in Adults. 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2010: 906-946.
2. Mehta JA, Bain GI. Posterolateral rotatory instability of the elbow. J Am Acad Orthop Surg, 2004, 12(6): 405-415.
3. Fitzpatrick MJ, Diltz M, McGarry MH, et al. A new fracture model for “terrible triad” injuries of the elbow: influence of forearm rotation on injury patterns. J Orthop Trauma, 2012, 26(10): 591-596.
4. Guitton TG, Ring D. Nonsurgically treated terrible triad injuries of the elbow: report of four cases. J Hand Surg (Am), 2010, 35(3): 464-467.
5. Mathew PK, Athwal GS, King GJ. Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg, 2009, 17(3): 137-151.
6. Cheung EV, Steinmann SP. Surgical approaches to the elbow. J Am Acad Orthop Surg, 2009, 17(5): 325-333.
7. 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.
8. Garrigues GE, Wray WH 3rd, Lindenhovius AL, et al. Fixation of the coronoid process in elbow fracture-dislocations. J Bone Joint Surg (Am), 2011, 93(20): 1873-1881.
9. 匡新建, 蔡航, 鮑豐, 等. 肘關節恐怖三聯征的手術治療. 中國修復重建外科雜志, 2011, 25(8): 964-967.
10. 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.
11. Pai V, Pai V. Use of suture anchors for coronoid fractures in the terrible triad of the elbow. J Orthop Surg (Hong Kong), 2009, 17(1): 31-35.
12. 匡新建, 蔡航, 鮑豐, 等. 微型鋼板治療尺骨冠狀突骨折. 中國修復重建外科雜志, 2010, 24(9): 1097-1099.
13. Ring D, Guss D, Jupiter JB. Reconstruction of the coronoid process using a fragment of discarded radial head. J Hand Surg (Am), 2012, 37(3): 570-574.
14. Leigh WB, Ball CM. Radial head reconstruction versus replacement in the treatment of terrible triad injuries of the elbow. J Shoulder Elbow Surg, 2012, 21(10): 1336-1341.
15. Turner RG, Rispoli D, Lopez-Gonzalez FM, et al. Partial allograft replacement of the radial head in the management of complex fracture-dislocations of the elbow. J Shoulder Elbow Surg, 2012, 21(3): 396-404.
16. Pugh DM, Wild LM, Schemitsch EH, et al. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg (Am), 2004, 86-A(6): 1122-1130.
17. Ring D, Hannouche D, Jupiter JB. Surgical treatment of persistent dislocation or subluxation of the ulnohumeral joint after fracture-dislocation of the elbow. J Hand Surg (Am), 2004, 29(3): 470-480.
18. Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg (Am), 2002, 84-A(4): 547-551.
19. Forthman C, Henket M, Ring DC. Elbow dislocation with intra-articular fracture: the results of operative treatment without repair of the medial collateral ligament. J Hand Surg (Am), 2007, 32(8): 1200-1209.
20. Rodriguez-Martin J, Pretell-Mazzini J, Andres-Esteban EM, et al. Outcomes after terrible triads of the elbow treated with the current surgical protocols. A review. Int Orthop, 2011, 35(6): 851-860.
21. 陳碩, 黃富國, 胡曉川, 等. 肘關節“恐怖三聯征”的手術治療. 中國修復重建外科雜志, 2009, 23(1): 45-48.
22. Jeong WK, Oh JK, Hwang JH, et al. Results of terrible triads in the elbow: the advantage of primary restoration of medial structure. J Orthop Sci, 2010, 15(5): 612-619.
23. 張世民, 俞光榮, 袁鋒, 等. 肘關節后脫位伴橈骨頭和尺骨冠突骨折(恐怖三聯征)5例初步報告. 中國矯形外科雜志, 2007, 15(14): 1069-1073.
24. Toros T, Ozaksar K, Sugun TS, et al. The effect of medial side repair in terrible triad injury of the elbow. Acta Orthop Traumatol Turc, 2012, 46(2): 96-101.
25. Chemama B, Bonnevialle N, Peter O, et al. Terrible triad injury of the elbow: how to improve outcomes. Orthop Traumatol Surg Res, 2010, 96(2): 147-154.
26. Rhyou IH, Kim YS. New mechanism of the posterior elbow dislocation. Knee Surg Sports Traumatol Arthrosc, 2012, 20(12): 2535-2541.
27. Chen NC, Julka A. Hinged external fixation of the elbow. Hand Clin, 2010, 26(3): 423-433, vii.
28. Volkov MV, Oganesian OV. Restoration of function in the knee and elbow with a hinge-distractor apparatus. J Bone Joint Surg (Am), 1975, 57(5): 591-600.

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肘關節恐怖三聯征的治療進展

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肘關節恐怖三聯征的治療進展

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