桡骨头骨折合并尺侧副韧带损伤的手术治疗  

Surgical therapy of radial head fractures combined with ulnar collateral ligament injuries

作　　者：张殿英[1] 付中国[1] 党育[1] 姜保国[1] 

机构地区：[1]北京大学人民医院创伤骨科,北京大学交通医学中心,100044

出　　处：《中华创伤杂志》2012年第2期104-108,共5页Chinese Journal of Trauma

基　　金：卫生公益性行业科研专项资助项目（201002014）;国家＂十一五＂科技支撑计划资助项目（2005 CB522604）;国家杰出青年科学基金资助项目（30625036）;国家自然科学基金资助项目（30801169,30971526,30973066）;北京市科技新星资助项目（A-2008-10）;首都医学发展科研基金资助项目（2007-2011）;北京市自然科学基金资助项目（7113170）;教育部博士点新教师基金资助项目（20090001120096）

摘　　要：目的分析桡骨头骨折合并尺侧副韧带损伤的治疗方法及其疗效。方法对2004年8月-2011年1月收治的桡骨头骨折伴尺侧副韧带损伤行手术治疗的38例患者进行随访，其中24例获得随访且资料完整。按改良Mason分型：Ⅱ型6例，Ⅲ型15例，Ⅳ型3例。分别采用普通螺钉、Herbert钉、空心螺钉、可吸收钉及微型钢板固定，骨折粉碎严重行桡骨头置换术。侧副韧带复合体的修复采用直接缝合，如不能缝合则重建韧带。结果本组获得10～84个月随访，平均37．1个月。按Mayo肘关节功能评分评定：优18例，良4例，一般2例，优良率为92％。结论对于MasonⅡ型以上的桡骨头骨折合并尺侧副韧带损伤患者，应首选桡骨头重建术，不能夏建应行桡骨头置换。桡骨头重建术中在修复其他合并损伤后肘关节仍出现外翻不稳定，应对尺侧副韧带进行修复或重建。桡骨头置换术中应I期修复及重建肘关节桡尺侧副韧带。Objective To analyze treatment methods for radial head fractures combined with ulnar collateral ligament injuries and discuss the related effects. Methods A total of 38 patients undergone operations for radial head fractures combined with ulnar collateral ligament injuries from August 2004to January 2011 at People＇ s Hospital of Peking University were followed up and 24 patients had complete follow-up data.According to the modified Mason typing,there were six patients with Mason-Johnston type Ⅱ fractures,15 with type Ⅲ and three with type Ⅳ. Conventional screws,Herbert screws,hollow screws,absorbable screws and mini-type plates were used for fracture fixation respectively.Severe communicated fractures were treated with radial head replacement and the injured collateral ligament complex with direct suture or ligament reconstruction. Results The duration of follow-up was 10-84 months （average 37.1 months）.According to the Mayo Elbow-Performance Score,the results were excellent in 18 patients,good in four and fair in two,with excellence rate of 92%. Conclusions For the radial head fractures combined with ulnar collateral ligament injuries （severer than Mason type Ⅱ ）,the first choice should be radial head reconstruction.If the fractures cannot be reconstructed,the radial head replacement is the best choice.If there still exists the elbow valgus instability after radial head reconstruction,the ulnar collateral ligament should be repaired or constructed.Primary repair and reconstruction of the radial and ulnar collateral ligaments is necessary when the radial head replacement is performed.

关 键 词：桡骨骨折 骨折固定术 内 侧副韧带 

分 类 号：R687.3[医药卫生—骨科学]