目的：分析无手术史的陈旧性冠状突骨折、桡骨头骨折合并肘关节脱位（即肘关节“三联征”）的手术方法及效果。方法：回顾性分析自2009年3月至2014年2月接受治疗的11例无手术史的陈旧肘关节“三联征”患者的病例资料及随访结果，男9例，女2例，平均年龄(31.82±8.66)岁（17~45岁）。患者受伤至手术时间平均为(6.36±2.50)周（4~12周）， 左侧7例，右侧4例。损伤原因为摔伤9例，车祸伤1例，高处坠落伤1例。合并伤包括2例合并桡骨远端骨折，1例合并踝关节骨折、桡骨远端骨折和头颅损伤（轻微的硬膜外血肿，未手术），1例合并Pilon骨折和腰椎L4骨折（在当地医院已手术）。所有患者均为肘关节僵硬、关节脱位，其中2例合并尺神经症状。桡骨头骨折Mason分型为：Ⅰ型2例，Ⅱ型5例，Ⅲ型4例；尺骨冠状突骨折分型为：Regan & Morrey Ⅰ型1例，Ⅱ型10例，Ⅲ型0例；按O’Driscoll分型均为冠状突尖部骨折，第1亚型1例，第2亚型10例。肘关节处于半脱位状态3例，完全脱位状态8例。10例为内、外侧联合切口，1例为外侧单一切口，行关节松解、冠状突骨折套索缝合结合克氏针固定。桡骨头骨折的处理：1例行桡骨头切除；1例行人工组配型桡骨头假体置换；3例骨折位置可，不予处理；6例行截骨，清理骨折端，Synthes 3.0 mm埋头空心加压螺钉（headless compression screw，HCS）固定。2例经骨孔对外侧副韧带复合体+伸肌总腱起点进行修复，9例采用缝合锚进行修复。11例患者均采用Stryker DJD Ⅱ铰链式可活动外固定架以保护骨与软组织的修复。结果：术后平均随访时间为(38.36±21.92)个月（19~77个月）。平均屈肘134.09°±12.41°（100°~140°），平均伸肘-15.91°±14.46°（-40°~0°），平均屈伸活动范围为118.18°±23.80°（70°~140°），前臂平均旋前70.91°±26.63°（20°~90°），平均旋后70.91°±26.63°（20°~100°），平均旋转活动范围150.91°±43.00°（40°~180°），平均Mayo肘关节功能评分（Mayo elbow performance score, MEPS）为（96.36±5.04）分（85~100分）。本组11例均没有发生明显疼痛、不稳定、感染及神经损伤等并发症。X线片评价结果：11例患者均无退行性变表现，有5例患者出现了不同程度的异位骨化，按Hastings和Graham分级为Ⅰ级1例，ⅡA级3例，ⅡB级1例。结论：无手术史的陈旧性肘关节“三联征”治疗困难，可通过彻底关节松解，对冠状突+前关节囊、桡骨头骨折、外侧副韧带和伸肌总腱止点进行修复和处理，结合铰链式外固定架，可获得良好的结果，关节僵硬和异位骨化是较常见的并发症。

Objective：To introduce the surgical techniques and treating results of the old “terrible triad” of the elbow. Methods: A retrospective analysis of 11 cases of old “terrible triad” of the elbow treated by the author from March 2009 to February 2014 were performed， with 9 males and 2 females; mean age was (31.82±8.66) years (17-45 years). The average time after injury was (6.36±2.50) weeks (4-12 weeks), with 7 cases on the left and 4 right. The combined injury included 2 cases with distal radius fractures, 1 with ankle fractures, fractures of the distal radius and the head injury (minor epidural hematoma, no surgery), and 1 with Pilon fractures and L4 fractures (fixed at local hospital). All the patients had elbow stiffness and joint dislocation, and 2 patients had symptoms of ulnar nerve. Mason classification of radial head fractures: 2 cases were type Ⅰ, 5 were type Ⅱ, 4 were type Ⅲ. Classification of the coronoid process: Regan & Morrey: 1 was type Ⅰ, 10 were type Ⅱ; according to O’Driscoll classification, all the fractures were tip fracture, one was the first subtype, 10 were the second subtype. The elbow were released, the coronoid process were fixed by lasso suture combined with Kirschner wires. Radial head fractures were resected in 1 case, and replaced in 1 case, 3 cases with no treatment, 6 cases with osteotomy and 3.0 mm headless compression screw (HCS) fixation. The lateral collateral ligament complex and the common extensor tendon were repaired to the humeral lateral epicondyles, No.2 Ethibon was used in 2 cases through bone holes, and suture anchorsin the other 9 cases. All the patients were fixed by Stryker DJD Ⅱ hinged external fixator to protect the bone and soft tissue.  Results: The average follow-up time was (38.36±21.92) months (19-77 months). All the patients had no obvious pain, instability and ulnar nerve symptoms in the last follow-up. The average elbow flexion was 134.09°±12.41° (100°-140°), average extension was -15.91°±14.46° (-40°-0°), range of flexion and extension was 118.18°±23.80° (70°-140°). Average pronation was 70.91°±26.63° (20°-90°), supination was 70.91°±26.63° (20°-100°). The range of motion (ROM) of forearm rotation was 150.91°±43.00° (40°-180°). Average Mayo elbow performance score (MEPS) was 96.36±5.04 (85-100).X-ray showed that no degenerative changes. Five patients had heterotopic ossifications, according to Hastings and Graham grading: 1 case was grade Ⅰ, 3 cases were grade ⅡA, 1 case was ⅡB. Conclusion: The old “terrible triad” of elbow with no operative history is difficult to treat. The elbow’s functions and stabilization can be recovered by thorough elbow release, repair of coronoid process and anterior capsule, radial head fractures, lateral collateral ligament and the common extensor tendon insertion, combined with hinged external fixator. Joint stiffness and heterotopic ossification are common complications.