目的:探讨经肘内外侧联合入路治疗成人肘关节内翻后内侧旋转不稳定的疗效。方法:回顾性分析2017年5月至2018年12月郑州市骨科医院上肢骨科收治的20例肘关节内翻后内侧旋转不稳定患者资料。男13例，女7例；年龄36~65岁，平均46岁。尺骨冠突骨折按O'Driscoll分型：ⅡA型15例，ⅡB型4例，ⅡC型1例。内侧入路给予冠状突骨折直视下复位、克氏针或空心螺钉固定，然后置入冠状突专用钢板辅助支撑固定；20例患者的肘关节外侧不稳，常规给予外侧入路带线锚钉缝合外侧副韧带复合体。记录患者骨折愈合情况、末次随访时肘关节屈伸及前臂旋转活动度、疗效。结果:所有患者平均手术时间72 min，术中平均出血85 mL，平均住院时间12.5 d。20例患者术后获平均14.5个月随访。手术切口均为甲级愈合；冠状突骨折均获骨性愈合。全部患者肘关节活动稳定，无内置物松动、断裂。2例患者出现创伤性关节炎，3例患者出现异位骨化。末次随访时患者肘关节功能：屈曲平均113.2°，伸直平均10.3°，前臂旋前平均72.4°，前臂旋后平均83.4°。末次随访时按Mayo肘关节功能评分标准评定疗效：优15例，良5例，优良率为100%(20/20)；评分平均88.5分。结论:肘关节内翻后内侧旋转不稳定为肘关节损伤的一种特殊类型，通过内侧入路复位并坚强固定冠状突骨块同时修复内侧副韧带，外侧入路探查修复外侧副韧带，指导患者早期肘关节功能锻炼可以取得较好的临床疗效。“,”Objective:To explore the therapeutic effects of combined medial and lateral elbow approaches on elbow varus posteromedial rotatory instability.Methods:A retrospective study was conducted of the 20 patients who had been treated from May 2017 to December 2018 at Department of Upper Limb Orthopaedics, Zhengzhou Orthopaedics Hospital for elbow varus posteromedial rotatory instability. They were 13 males and 7 females, aged from 36 to 65 years (mean, 46 years). According to the O'Driscoll classification, the fractures of ulnar coronoid process were type ⅡA in 15 cases, type ⅡB in 4 cases and type ⅡC in one. All of them were treated by combined medial and lateral elbow approaches. The medial approach was used for reduction under direct vision and fixation of coronary process fracture with Kirschner wire or hollow screws, and supportive posterior fixation with special coronal process plate. The lateral approach was used for suture anchor of lateral collateral ligament complex in the 20 cases of lateral elbow instability. The fracture healing, elbow flexion and extension and forearm rotation were followed up; the therapeutic effects were evaluated by the Mayo elbow performance score (MEPS) at the last follow-up.Results:For all patients, operation time averaged 72 minutes, intraoperative bleeding 85 mL and hospitalization time 12.5 days. All the 20 patients were followed up for an average of 14.5 months. The incision healing was all rated as grade A. All the coronary process fractures obtained bony union. All the patients restored stable elbow movement. No loosening or breakage of the implants was observed. Traumatic arthritis occurred in 2 patients and ectopic ossification in 3. At the last follow-up, elbow flexion averaged 113.2°, elbow extension 10.3°, forearm pronation 72.4° and forearm pronation 83.4°. By MEPS, the elbow function at the last follow-up was rated as excellent in 15 cases and as good in 5, giving an excellent to good rate of 100% (20/20) and an average score of 88.5 points.Conclusions:As a special type of elbow joint injury, elbow varus posteromedial rotatory instability can be treated by the medial elbow approach for reduction and rigid fixation of coronal process bone blocks to repair the medial collateral ligament and by the lateral elbow approach to explore and repair the lateral collateral ligament. Surgical treatment should be followed by early functional exercise of the elbow joint in order to achieve fine therapeutic effects.