比较内外侧联合入路与单纯外侧入路在治疗肘关节恐怖三联征（terrible triad injury of the elbow，TTE）时术中指标和术后疗效的差异。

按照检索策略分别检索发表在Embase、Pubmed、Cochrane Library、Cinahl、万方、中国知网等数据库中关于内外侧联合入路和外侧入路治疗TTE的文献，共检索到相关文献679篇，并最终纳入13篇文献。依据Cochrane系统评价方法学对文献进行质量评价，将提取的数据用Review manager 5.4软件进行Meta分析。

在治疗TTE时内外侧联合入路的手术时间和术中失血量要高于外侧入路，其差异均具有统计学意义[95% CI（5.43，34.01），P=0.007][95% CI（5.57，23.46），P=0.001]。然而，通过比较结果显示内外侧联合入路的术后关节活动度高于外侧入路[95% CI（9.16,19.25），P<0.01]。另外在视觉模拟评分、Mayo肘关节功能评分系统、优良率和并发症发生等方面，两组间差异无统计学意义。

在治疗TTE时外侧入路具有手术时间短、出血量少的优势，但内外侧联合入路手术术后肘关节活动度较好。因此，两种手术入路的选择需根据病情具体分析。

Terrible triad injury of the elbow (TTE) is a complex dislocation of the elbow caused by severe violent impact. The elbow is usually in a straight state when the patient is injured, and the impact force is transmitted to the elbow along the longitudinal axis of the forearm and is often accompanied by large shear force. Young people who are involved in car accidents or crashes are the main demographic for TTE. It is mainly characterized by posterior dislocation of the elbow joint with fractures of the coronoid process of the ulna and the head of the radius. TTE is mainly caused by compression and shear force exerted on the longitudinal axis of the extended upper limb. Currently, TTE is mainly treated by surgery in order to restore elbow joint function and improve prognosis. Currently, the mainstream surgical approaches for TTE include medial approach, lateral approach and combined internal and external approach. The selection of reasonable approach and internal fixation can effectively reduce postoperative elbow pain, stiffness, ectopic ossification, traumatic arthritis and other complications, and have certain positive effects on the recovery of elbow joint function of patients, thus improving the quality of life of patients.

To compare the intraoperative indexes and postoperative efficacy of the combined internal and lateral approach and the single lateral approach in the treatment of TTE.

According to the search strategy, the literature published in Embase, Pubmed, Cochrane Library, Cinahl, WanfangData, CNKI and other databases on the treatment of elbow terror triad by combined internal-lateral approach and lateral approach was searched respectively. A total of 679 relevant literatures were retrieved, and 13 literatures were finally included. The literature quality was evaluated according to Cochrane systematic Review methodology, and the extracted data was used for meta-analysis using Review manager 5.4 software.

In the treatment of elbow terror triad, the operative time and intraoperative blood loss of the combined internal-lateral approach were higher than those of the lateral approach, and the differences were statistically significant [95% CI (5.43, 34.01), P=0.007][95% CI (5.57, 23.46), P=0.001]. However, the results of the comparison showed that the postoperative joint motion of the combined internal-lateral approach was higher than that of the lateral approach [95% CI (9.16,19.25), P<0.01]. In addition, there were no significant differences in VAS score, MEPS score, excellent rate and complications between the two groups.

In the treatment of TTE, the lateral approach has the advantages of short operation time and less blood loss, but the elbow joint motion after the combined internal and lateral approach is better. Therefore, the choice of the two surgical approaches needs to be analyzed according to the specific conditions of the disease.