微型钢板治疗桡骨小头骨折安全区的确定  

The position determination of “safe zone”in the treatment of radial head fracture with mini-plate

作　　者：庄云强[1] 张军[1] 周龙[1] 景灵勇[1] 刘观燚[1] 

机构地区：[1]宁波市第六医院,浙江315040

出　　处：《创伤外科杂志》2016年第11期656-658,共3页Journal of Traumatic Surgery

基　　金：2014年浙江省医药卫生科技计划项目(2014KYA201)

摘　　要：目的确定微型钢板固定桡骨小头骨折术中安全区范围,避免钢板固定对上尺桡关节旋转的影响及术中对桡神经深支及血运的破坏,最大程度地恢复肘关节的功能。方法回顾性分析2012年1月-2014年11月收治的45例在确定安全区后采用微型钢板手术治疗的桡骨小头骨折,其中MasonⅡ型30例,MasonⅢ型15例。男性23例,女性22例;年龄18-69岁（平均41.5岁）。术中按照桡骨小头解剖位置（Smith法）、周围关节软骨形态、Caputo法及前臂旋转方法确定钢板放置后对上尺桡关节旋转有无影响。结果经过12-18个月的随访（平均15.1个月）,术后肘关节伸屈弧度平均为135°（100°-145°）;前臂旋转范围平均为126°（120°-150°）,旋前平均为53°（45°-65°）,旋后平均为73°（65°-76°）。按Broberg-Morrey评估标准：优32例、良10例、可3例,优良率93.3%。随访期间,出现2例内固定失效,钢板、螺钉松脱,影响旋转功能,未出现骨折不愈合、桡骨小头坏死、感染及桡神经损伤等并发症。结论微型钢板内固定治疗桡骨小头骨折,钢板放置于安全区内对前臂旋转无影响,术中可通过4种方法综合使用来确定微型钢板放置的安全区。Objective To study the position of the safe zone of radial head fracture with miniplate in order to avoid side effects on the forearm＇s rotating range and reduce damages of nerve and blood supply system,so as to realize the maximum function recovery of the forearm. Methods Totally 45 cases of radial head fracture from Jan. 2012 to Nov. 2014 treated in our hospital was retrospectively studied. Mini-plates were used in all 45 cases after determining the safe zone,among which 30 cases were Mason Type Ⅱ and 15 cases were Mason Type Ⅲ,including 23 male cases and 22 female cases with an average of 41. 5（ 18-69） years old. Four methods（ the anatomical location of the radial head,the shape of articular cartilage,the methods of Caputo and the forearm rotation） were used to confirm the influence of plates position on the rotation of ulnar radial joints. Results All of the 45 patients were followed up for 12 to18 months with an average of 15. 1 months. The average postoperative elbow flexion arc was 135°（ 100 °-145 °）,the average range of forearm rotation was 126°（ 120°-150°）,the average pronation was 53°（ 45°-65°） and the average supination was 73°（ 65°-76°）. According to the evaluation standards of Broberg-Morrey,the outcome was excellent in 32 cases,good in 10 cases,fair in 3 cases,and the excellent and good rate was 93. 3%. During the follow-up,fixation failure and loosened plate and screw occurred in two cases,restricting the activity of the proximal radio-ulnar joint. No case occurred nonunion,necrosis,infection or radial nerve injury. Conclusion There is no effect on the rotation of forearm when the plate is plated in the safe zone,and four methods can be used in determining the safe zone.

关 键 词：桡骨小头骨折 内固定 钢板 安全区 

分 类 号：R683.41[医药卫生—骨科学]