On table重建联合微型钢板固定与桡骨头置换治疗桡骨头Mason Ⅲ、Ⅳ型骨折  

On-table reconstruction technique combined with mini plate fixation and radial head replacement in the treatment of Mason typeⅢandⅣof the radial head fractures

作　　者：韩雷[1] 胡云根[1] 方伟利 金波[1] 许世超[1] 王拓[1] Han Lei;Hu Yungen;Fang Weili;Jin Bo;Xu Shichao;Wang Tuo(Department of Orthopedics,Traditional Chinese Medical Hospital of Xiaoshan,Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine,Hangzhou 311201,China)

机构地区：[1]浙江中医药大学附属江南医院,杭州市萧山中医院骨科,杭州311201

出　　处：《中华手外科杂志》2021年第6期430-433,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨On table重建联合微型钢板固定和桡骨头置换治疗桡骨小头Mason Ⅲ、Ⅳ型骨折的临床疗效并对比分析。方法自2012年1月至2019年1月我科收治桡骨头Mason Ⅲ、Ⅳ型患者42例,分为两组:A组24例采用On table重建联合微型钢板固定治疗;B组18例采用桡骨头置换。所有患者均为新鲜骨折,受伤至手术时间为24 h至10 d,平均4.5 d。两组患者一般资料比较差异均无统计学意义(P>0.05)。术后随访常规摄X线片观察骨折愈合、假体位置情况,肘关节功能采用Broberg-Morrey以及DASH问卷进行评价。结果两组患者均获得随访,平均10.5个月(6~30个月)。两组均无感染、神经损伤、内固定或假体松动等并发症发生,A组出现1例创伤性关节炎。术后1、3、6个月B组Broberg-Morrey评分为84.5±7.2、86.8±6.4和89.6±3.8,均高于A组80.6±6.2、81.9±5.8和84.4±5.2,差异有统计学意义(P<0.05);末次随访时A组为91.2±8.1,同B组92.1±7.4比较差异无统计学意义(P>0.05)。术后1、3、6个月B组DASH评分为21.1±5.2、17.5±4.1及13.3±3.1,较A组25.1±4.7、21.4±4.2及19.2±3.7下降明显,差异有统计学意义(P<0.05);末次随访时A组为11.5±3.1,同B组12.1±3.4比较差异无统计学意义(P>0.05)。结论 On table重建联合微型钢板固定和桡骨头置换均能有效治疗桡骨小头Mason Ⅲ、Ⅳ型骨折,两者术后末次随访肘关节功能恢复无差异,但桡骨头置换术可以更快恢复肘关节功能。Objective To investigate the clinical efficacy of On-table reconstruction technique combined with mini plate fixation and radial head replacement in the treatment of Mason typeⅢandⅣof the radial head fractures.Methods From January 2012 to January 2019,42 patients with Mason typeⅢandⅣof the radial head fractures were randomly divided into two groups:24 patients in group A were treated with On-table reconstruction technique combined with mini plate fixation;18 patients in group B were treated with radial head replacement.All the patients had fresh fractures.The time from injury to operation ranged from 24 hours to 10 days,with an average of 4.5 days.There was no significant difference in general data between the two groups(P>0.05).The fracture healing and prosthesis position were observed by routine X-ray films.The elbow function was evaluated by Broberg-Morrey score system and DASH questionnaire.Results Both groups were follow-up for an average of 10.5 months(ranged,6 to 30 months).There were no complications such as infection,nerve injury,internal fixation or prosthesis loosening in both groups.There was 1 case of traumatic arthritis in group A.At 1,3 and 6 months after operation,the Broberg-Morrey scores in group B were 84.5±7.2,86.8±6.4 and 89.6±3.8,which were significantly higher than those in group A(80.6±6.2,81.9±5.8 and 84.4±5.2,P<0.05).At the last follow-up,group A was 91.2±8.1,and there was no significant difference compared with group B(92.1±7.4,P>0.05).At 1,3 and 6 months after operation,the DASH scores in group B were 21.1±5.2,17.5±4.1 and 13.3±3.1,which were significantly lower than those in group A(25.1±4.7,21.4±4.2 and 19.2±3.7,P<0.05).At the last follow-up,group A was 11.5±3.1,and there was no significant difference compared with group B(12.1±3.4,P>0.05).Conclusion The On-table reconstruction technique combined with mini plate fixation and radial head replacement can effectively treat Mason typeⅢandⅣof the radial head fractures.There is no difference in the recovery of e

关 键 词：骨折固定术 内 对比研究 桡骨头骨折 桡骨头置换 

分 类 号：R687.3[医药卫生—骨科学]