切开复位内固定与桡骨小头假体置换治疗MasonⅢ型桡骨小头骨折疗效比较  

EFFECTIVENESS COMPARISON BETWEEN OPEN REDUCTION COMBINED WITH INTERNAL FIXATION AND ARTIFICIAL RADIAL HEAD REPLACEMENT IN TREATING MASON TYPE-III COMMINUTED FRACTURES OF RADIAL HEAD

作　　者：刘碧峰[1] 林志金[1] 曹烈虎[1] 康一凡[1] 

机构地区：[1]第二军医大学附属长海医院骨科,上海200433

出　　处：《中国修复重建外科杂志》2010年第8期900-903,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较切开复位内固定与桡骨小头假体置换治疗MasonⅢ型桡骨小头骨折的疗效,为临床选择治疗方法提供依据。方法 2004年1月-2008年6月,收治65例MasonⅢ型桡骨小头骨折,其中35例采用切开复位、AO微型钢板螺钉内固定系统或结合克氏针治疗(内固定组),30例采用金属单极桡骨小头假体置换治疗(置换组)。内固定组:男21例,女14例;年龄21～35岁,平均30.7岁。致伤原因:交通事故伤12例,高处坠落伤8例,摔伤15例。左侧23例,右侧12例。受伤至手术时间为1～7d,平均3d。置换组:男19例,女11例;年龄23～67岁,平均32.5岁。致伤原因:交通事故伤7例,高处坠落伤8例,摔伤15例。左侧17例,右侧13例。受伤至手术时间为1～6d,平均1.5d。两组患者性别、年龄、致伤原因、病程等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果术后两组切口均Ⅰ期愈合。患者均获随访,随访时间1～4年,平均2.5年。术后1年内固定组肘关节伸、屈及前臂旋转活动度与置换组比较,差异均有统计学意义(P<0.05);但两组前臂等长伸、屈及旋转肌力减弱比较,差异均无统计学意义(P>0.05)。内固定组29例骨折临床愈合,2例骨折延迟愈合,2例骨不连伴异位骨化,2例内固定失败。置换组术后1年1例肘关节屈曲角度丢失>30°;1例因假体过长,引起肘关节僵硬。术后1年根据Broberg和Morrey肘关节功能评分标准进行评定,内固定组总分为(69.51±10.23)分,置换组为(81.55±12.06)分,差异有统计学意义(P<0.05);其中内固定组获优15例,良5例,一般11例,差4例,优良率57.1%;置换组获优17例,良5例,一般6例,差2例,优良率73.3%。结论与切开复位内固定治疗相比,桡骨小头假体置换术治疗MasonⅢ型桡骨小头骨折可获得更好的肘关节功能。Objective To compare the effectiveness between open reduction combined with internal fixation and artificial radial head replacement in treating Mason type-III comminuted fracture of radial head, to provide the evidence for available treatment methods. Methods Between January 2004 and June 2008, 65 cases of Mason type-III comminuted fractures were treated with open reduction, AO mini plate and screw system or a combination of Kirschner treatment （internal fixation group, n=35） and with artificial radial head replacement （replacement group, n=30）. In internal fixation group, there were 21 males and 14 females with an age range of 21 to 35 years （mean, 30.7 years）; the causes of injury were traffic accident in 12 cases, falling from height in 8 cases, and a fall in 15 cases; the locations were left side in 23 cases and right side in 12 cases; and the time between injury and surgery was 1-7 days （mean, 3 days）. In replacement group, there were 19 males and 11 females with an age range of 23 to 67 years （mean, 32.5 years）; the causes of injury were traffic accident in 7 cases, falling from height in 8 cases, and a fall in 15 cases; the locations were left side in 17 cases and right side in 13 cases; and the time between injury and surgery was 1-6 days （mean, 1.5 days）. There was no significant difference in gender, age, disease cause, disease duration, or other general information between 2 groups （P〈0.05）, so that 2 series of patients had comparability. Results Incisions healed primarily in 2 groups. All patients were followed up 1 to 4 years with an average of 2.5 years. There were significant differences in elbow flexion angle, extension angle, and forearm rotation angle between 2 groups （P〈0.05）, but no significant difference in elbow pronation or supination weakness （P〈0.05）. In internal fixation group, primary union occurred in 29 cases, delayed union in 2 cases, nonunion with ectopic ossification in 2 cases, and internal fixation failure in 2 cases. In replacement grou

关 键 词：MasonⅢ型桡骨小头骨折 内固定 人工假体置换 疗效比较 

分 类 号：R687.3[医药卫生—骨科学]