TERRIBLE TRIAD OF THE ELBOW: FUNCTIONAL RESULTS OF SURGICAL TREATMENT

ABSTRACT Objective: To evaluate the functional and radiographic results of patients who underwent surgical treatment for terrible triad-type elbow injuries (TTE). Methods: We retrospectively evaluated 20 patients, including one case with bilateral injuries (total of 21 elbows) that were surgically treated from January 2004 to July 2014. We evaluated the functional results of treatment by measuring the restored range of motion (ROM) of the elbow, using the DASH (Disabilities of the Arm, Shoulder and Hand) and MEPS (Mayo Elbow Performance Score) scores. Complications and the development of osteoarthritis and heterotopic ossification (HO) were also evaluated. Results: Eight elbows (38%) required additional surgical treatment; HO was observed in eight elbows (38%) and severe osteoarthritis (Broberg-Morrey type IV) was seen in only one case (4%). Nevertheless, we obtained good functional results, 14.27 on the DASH and 84 on the MEPS. The average ROM for flexion-extension was 101° (20-140°) and for pronation-supination was 112.85° (0-180°). Conclusion: When TTE injuries are treated systematically, even despite variations in these injuries, functional ROM and scores ranging from good to excellent can be obtained. Level of Evidence IV, Case Series.

摘要
研究目的：评估接受手术治疗的恐怖三联征型肘关节损伤（terrible triad-type elbow injuries, TTE）患者的功能与影像学预后。
研究方法：回顾性分析2004年1月至2014年7月间接受手术治疗的20例患者，其中1例为双侧损伤，共计21个肘关节。通过测量肘关节恢复后的活动范围（range of motion, ROM）、采用上肢功能障碍评分表（Disabilities of the Arm, Shoulder and Hand, DASH）与Mayo肘关节功能评分（Mayo Elbow Performance Score, MEPS）评估治疗的功能预后；同时评估并发症、骨关节炎发生情况及异位骨化（heterotopic ossification, HO）的发展情况。
研究结果：8个肘关节（38%）需接受二次手术治疗；8个肘关节（38%）观察到异位骨化，仅1例（4%）出现重度骨关节炎（Broberg-Morrey IV型）。最终获得了良好的功能预后：DASH评分平均为14.27，MEPS评分平均为84。屈伸活动度平均为101°（范围20°~140°），旋前旋后活动度平均为112.85°（范围0°~180°）。
研究结论：若对恐怖三联征型肘关节损伤进行系统化治疗，尽管此类损伤存在个体差异，仍可获得良好至优秀的功能活动范围与评分。本研究证据级别为IV级，属于病例系列研究（Case Series）。