中文摘要：

目的探讨手术治疗肘关节＂恐怖三联征＂的手术疗效及治疗策略。方法回顾性分析2007年11月至2009年12月（北京大学人民医院、北京积水潭医院、首都医科大学宣武医院、四川大学华西医院、南方医科大学南方医院）手术治疗并获得完整随访的14例肘关节＂恐怖三联征＂患者的临床资料。男8例,女6例;年龄19～68岁,平均45岁。冠状突骨折按Regan-Morrey分型：Ⅰ型1例,Ⅱ型6例,Ⅲ型7例;桡骨头骨折按Mason分型：Ⅱ型2例,Ⅲ型8例,Ⅳ型4例。术中依次固定冠状突骨折和桡骨头骨折,修复侧副韧带,并根据具体情况应用铰链外固定架撑开固定。术后6个月按照Broberg ＆ Morrey、DASH、Mayo三种功能评分标准进行疗效评价。结果 14例患者全部获得随访,随访时间为3个月～3年,平均18.7个月。骨折达临床愈合为术后10～18周,平均12.6周。术后6个月,肘关节屈位（0°～20°）伸位（130°～140°）,平均活动范围为114.5°;旋前（60°～85°）旋后（45°～75°）,平均旋转范围为128°。Broberg ＆ Morrey功能评分标准进行疗效评价：优6例,良5例,一般2例,差1例;DASH评分标准评价：优7例,良4例,一般2例,差1例;Mayo评分标准评价：优7例,良3例,一般3例,差1例。1例出现肘关节僵硬;1例术后1天出现桡神经损伤症状,给予神经营养药物1个月后症状消失;3例术后6个月出现异位骨化。结论肘关节＂恐怖三联征＂造成肘关节严重不稳定,手术应尽可能恢复骨性解剖结构、修复关节囊及侧副韧带,并辅以外固定支架。术后进行早期功能锻炼,最大程度恢复关节功能。

英文摘要：

Objective To retrospectively review the operative effect of＂terrible triad＂of elbow joint and summary the suitable treatment strategy.Methods The clinical follow - up data of 14 patients with＂terrible triad＂were retrospectively reviewed from November 2007 to December 2009.There were 8 males and 6 females with an average age of 45 years （ranged from 19 to 68 years）.The coronoid process fractures were classified into 3 types with 1 cases of typeⅠ,6 cases of typeⅡand 7 cases of typeⅢaccording to Regan - Morrey classification.The radial head fractures were classified into 4 types with 2 cases of typeⅡ,8 cases of typeⅢand 4 cases of typeⅣaccording to Mason classification.Coronoid process fractures and radial head fractures were fixed,collateral ligament was repaired by turns and the external fixator was applied according to the specific condition.Broberg Morrey,DASH,Mayo functional assessment were applied after 6 months. Results The 14 patients were followed up from 3 to 36 months（average 18.7 months）.Fracture clinical healing was found after 10 - 18 weeks（average 12.6 weeks）.The elbow motion changed from flexion（0°-20°） to extension （130°-140°）,average motion of 114.5°;pronation（60°-85°）,supination（45°-75°）,average128°.According to Broberg Morrey functional assessment：excellent in 6 cases,good in 5,fair in 2 and poor 1.According to DASH：excellent in 7 cases,good in 4,fair in 2 and poor 1.According to Mayo：excellent in 7 cases,good in 3,fair in 3 and poor 1. Elbow stiffness was found in 1 case.Radial nerve injury was found in 1 case and recovered by using drugs.Ectopic ossification was found in 3 cases after 6 months.Conclusion The terrible triad of the elbow can lead to serious elbow instability and should be treated with operation to restore the anatomic structures,to repair the articular capsule and the collateral ligament,using the adjuvant hinged external fixator and early exercise to avoid immobilization and recover the articular function.