桡骨头骨折的诊疗策略  

Diagnosis and treatment strategy of radial head fracture

作　　者：田旭[1] 东靖明[1] Tian Xu;Dong Jingming(Department of No.2 Upper Extremity Traumatology,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院创伤上肢二病区,天津300211

出　　处：《中华骨科杂志》2022年第4期251-257,共7页Chinese Journal of Orthopaedics

摘　　要：桡骨头骨折是上肢创伤中的常见疾病,最主要的致伤原因是沿前臂的纵向暴力,常合并尺骨冠突骨折、肘关节韧带损伤、前臂骨间膜损伤、下尺桡关节损伤等。治疗桡骨头骨折时应根据具体的骨折类型决定采用何种方法。绝大多数的MasonⅠ型骨折通常可采用保守治疗,而对于MasonⅡ、Ⅲ型骨折则需要手术治疗。手术治疗方案通常包括桡骨头切除、切开复位内固定、桡骨头置换等。对不合并肘关节或前臂纵向不稳定的单纯粉碎性桡骨头骨折,可采用桡骨头切除的方法治疗,但如果合并肘关节或前臂纵向不稳定,则禁忌采用桡骨头切除术,建议使用内固定或桡骨头置换。鉴于目前对于桡骨头骨折的治疗逐渐规范化,本文将对桡骨头骨折的流行病学调查及解剖与生物力学、损伤机制、临床诊断以及治疗等内容进行综述,为临床患者的个体化治疗方案提供思路。Radial head fracture is a common disease in upper limb trauma.The most common cause of injury is longitudinal violence along the forearm,often associated with injuries,such as ulnar coronoid process fracture,elbow ligamentous injury,forearm interosseous membrane injury,distal radioulnar joint injury and so on.The treatment strategy of radial head fractures should be determined according to the specific fracture type of the patient.The vast majority of Mason I fractures can usually be treated conservatively,while Mason II and III fractures often require surgical treatment.The surgical treatment usually includes radial head excision,open reduction and internal fixation,and radial head prosthetic replacement.For simple comminted radial head fractures without longitudinal instability of the elbow or forearm,radial head resection can be used.However,if there is longitudinal instability of the elbow or forearm,radial head resection is contraindicated and internal fixation or radial head replacement is recommended.In view of the gradual standardization of the treatment of radial head fracture,this article will review the epidemiological investigation,anatomy and biomechanics,injury mechanism,clinical diagnosis and treatment of radial head fracture,so as to provide ideas for clinical selection of the best treatment scheme suitable for individual patients.

关 键 词：桡骨头骨折 桡骨头切除 切开复位内固定 诊疗策略 Ⅲ型骨折 临床患者 流行病学调查 生物力学 

分 类 号：R687.3[医药卫生—骨科学]