手术治疗合并肘关节脱位的桡骨头骨折  

Surgical treatment of radial head fractures with elbow dislocation

作　　者：刘观燚[1] 吴丹海[1] 应其翀 陈隆军 赵华国[1] 马维虎[1] 周雷杰[1] Liu Guanyi;Wu Danhai;Ying Qichong;Chen Longjun;Zhao Huaguo;Ma Weihu;Zhou Leijie(Department of Orthopedics,Ningbo No.6Hospital,Zhejiang315040,China)

机构地区：[1]宁波市第六医院骨科,浙江315040 [2]浙江三门君同骨伤医院,台州317100

出　　处：《中华手外科杂志》2018年第6期455-457,共3页Chinese Journal of Hand Surgery

基　　金：2018年新世纪151人才工程培养基金;2015年浙江省卫计委卫生高层次培养工程医坛新秀培养基金;2014年宁波市医学科技计划项目(2014A30);2015年宁波市自然基金项目(2015A610216).

摘　　要：目的 评价手术治疗桡骨头骨折合并肘关节脱位的临床结果。方法 回顾性分析自2013年10月至2016年10月在我院行切复内固定或桡骨头置换术治疗的22例Mason-Johnston Ⅳ型桡骨头骨折患者。MasonⅡ型骨折14例,Ⅲ型骨折8例。患者临床随访和影像学评价直至骨折愈合及肘关节功能进入平台期。功能评估采用Mayo时关节评分系统。结果 19例桡骨头骨折进行切复内固定术,3例进行桡骨头置换术。随访13-36个月,平均20个月。肘关节屈伸弧平均为(105±17)°,前臂旋转弧平均为(140±18)°。术后所有患者X线片显示维持肘关节同心圆复位,未发现关节不稳,桡骨头骨折复位和固定满意。桡骨头骨折愈合时间11~17周,平均12.5周。3例假体置换患者,术后未发现假体脱位等并发症。术后末次随访MEPS为60~100分,平均(91±7)分,功能为优8例,良13例,差1例。5例患者出现肘关节异位骨化,4例未进一步手术治疗,1例进行手术松解。结论 切复内固定或桡骨头置换术结合侧副韧带修复治疗桡骨头骨折合并肘关节脱位可获得较为满意的疗效。Objective To explore the clinical efficacy of surgical treatment for radial head fractures with elbow dislocation.Methods From October2013to October2016,22cases of Mason-Johnston type Ⅳ radial head fractures were performed surgical treatment.There were14cases of Mason type Ⅱ fracture and8 cases of typeⅢ fracture.The patients were followed up clinically and radiographically until the fracture healing and elbow function entering the plateau stage.The Mayo Elbow Performance Score(MEPS)was used for the functional assessment.Results Nineteen cases of radial head fractures underwent internal fixation,and3 cases underwent radial head replacement.The postoperative follow-up period ranged from13to36months with an average of20months.The elbow flexion and extension arc averaged(106±17)°,and the forearm rotation arc averaged(140±18)°.The X-ray films of all the patients showed that the concentric reduction of the elbow was maintained.No instability of the joint was found,and the reduction and fixation of the radial head fracture were satisfactory.The healing time of radial head fracture was11to17weeks with an average of12.5weeks.No complications such as prosthesis,dislocation were found after operation in the3cases of prosthetic replacement. At the last follow-up,MEPS was60to100points with an average of(91±7)points.The function was rated as excellent in8cases,good in13cases and poor in1case.There were5cases of elbow heterotopic ossification,4 cases without further surgical treatment.And1case underwent surgical release.ConclusionOpen reduction and internal fixation or radial head replacement combined with collateral ligament repair for the treatment of radial head fractures with elbow dislocation can obtain satisfactory clinical efficacy.

关 键 词：骨折 治疗结果 桡骨头 肘关节脱位 

分 类 号：R687.3[医药卫生—骨科学]