Comparison Of Curative Effect Of Anterior-external Combined Elbow Joint Approach And Internal-external Combined Approach In Treating Terrible Triad Of The Elbow

Objective:To explore and compare the clinical effects of the anterior-external combined elbow joint approach(anterior approach-kocher approach)and the internal-external combined approach(over the top approach-kocher approach)in the treatment of the terrible triad of the elbow.Methods:From September 2017 to January 2020,21 cases of the terrible triad of the elbow were treated by the same group of orthopedists in our hospital.According to the Regon-Morry classification of coronary fractures,there were 12 cases of type II and 9cases of type III.The radial head fractures were all classified as type IV according to the modified Johnson classification.There were 11 patients in the anterior and external combined surgery group(group A),8 males and 3 females,aged 21 to 58 years,with an average age of 39.3 years;7 cases of type II coronary fractures and 4 cases of type III.There were 10 patients in the internal and external combined surgery group(group B),6males and 4 females,aged 23 to 61 years,with an average of 41.2 years;5 patients with type II coronary fractures and 5 with type III.The surgical time,fracture healing time,elbow stability,elbow mobility,and Mayo Elbow Performance Score(MEPS)werecompared between the two groups.Results:There were no complications such as poor incision healing,fracture nonunion or deformity healing,and elbow instability.Patients in group A were followed up for 7 to 18 months,with an average of(11.0 ± 4.1)months;the operation time was 110.3 ± 8.9min,the fracture healing time was 12.9 ± 1.9 weeks,and the average elbow flexion and extension range was 128 ± 8.2 °.The rotation range was 158 ± 10.3 °,and the MEPS score was 88.7 ± 5.6.One case had slight numbness of the skin in the median innervation area after surgery,and completely recovered after 3 weeks of treatment with mecobalamin tablets.Patients in group B were followed up for 6 to 17 months,with an average of(12.1 ± 3.8)months;the operation time was 118.7 ± 7.3min,the fracture healing time was 13.1 ± 1.7 weeks,and the range of postoperative elbow flexion and extension was 120 ± 9.8 °.Rotation The range was 149 ± 11.5 °,and the MEPS score was 82.9 ± 7.2.There was no significant difference in fracture healing time between the two groups(P> 0.05);there was a significant difference in surgical time,elbow mobility,and Mayo elbow function score between the two groups(P <0.05).Conclusion:Anterior-external combined approach or internal-external combined approach is safe and effective for the treatment of the triad of the elbow.However,anterior-external combined approach can be used for anatomic reduction of coronary process fractures under direct vision.The anterior and posterior screws and support plates are firmly fixed.In a short time,the patient's elbow function recovered better after surgery.