经肘前方入路在MasonⅡ型及Ⅲ型桡骨头骨折手术治疗的临床应用  

作　　者：连霄 陈庆铖 潘旭伟 毛新江 邱健 曾云记[1] 

机构地区：[1]杭州师范大学附属医院(杭州市第二人民医院),310015 [2]杭州师范大学,311121

出　　处：《浙江临床医学》2023年第7期1040-1042,共3页Zhejiang Clinical Medical Journal

基　　金：杭州市生物医药和健康产业发展扶持科技专项(2021WJCY137,2022WJC148)。

摘　　要：目的探讨经肘前方入路治疗MasonⅡ型及Ⅲ型桡骨头骨折的临床应用。方法回顾性分析2016年7月至2021年10月肘前方入路治疗桡骨头骨折16例患者的临床资料,男12例,女4例;年龄23~58岁;左侧5例,右侧10例,双侧1例。MasonⅡ型13例,MasonⅢ型3例。术前和术后随访均拍摄X线片以评估骨折的位置和骨折愈合情况。临床评价包括手术并发症,运动范围,Mayo肘关节功能评分。有14例使用加压螺钉内固定,1例使用微型钢板固定,1例行桡骨头置换。结果本组患者均获得11~28个月随访,所有患者均未发生异位骨化、神经损伤、肘关节瘢痕挛缩、内固定松动及断裂等并发症,影像学愈合时间为12~16周,平均为13.3周。在最后一次随访中,肘关节平均屈曲123.0°(110°~135°),平均伸直5°(0°~10°),前臂旋转活动度平均旋前84.5°(80°~90°),平均旋后85.0°(80°~90°)。Mayo肘关节功能评分为86~96分,其中优13例,良3例,优良率100%。结论肘关节前方入路软组织剥离少,桡骨头显露范围大,能直视下复位及固定重建,内固定方向选择更优化,疗效满意。Objective To investigate the clinical application of anterior elbow approach in the treatment of radial head fractures.Methods Retrospective analysis was made on 16 cases of radial head fracture treated by anterior elbow approach from July 2016 to October 2021,including 12 males and 4 females.The age ranged from 23 to 58 years.There were 5 cases on the left,10 cases on the right and 1 case on both sides.X-ray films were taken before and after the operation to evaluate the position of the fracture and the healing of the fracture.Clinical evaluation included analysis of surgical complications,range of motion,and Mayo elbow function score.14 cases were fixed with compression screws,1 case was fixed with mini plates,and 1 case was replaced with radial head.Results All cases in this group were followed up for 11-28 months.No complications such as heterotopic ossification,nerve injury,elbow joint scar contracture,internal fixation loosening and fracture occurred in all cases.The imaging healing time was 12~16 weeks,with an average of 13.5 weeks.In the last follow-up,the average elbow flexion was 120.0°(110°~135°),the average extension was 4.8°(0°~10°),the average forearm rotation was 86.0°(80°~90°)anterior,and the average supination was 85.0°(80°~90°)posterior.The Mayo elbow function score was 90~100 points,among which 13 cases were excellent,3 cases were good,and the excellent and good rate was 100%.Conclusion The anterior approach to the elbow joint has less soft tissue peeling,a large exposure range of the radial head,and direct vision reduction and fixation reconstruction.The direction of internal fixation is more optimized,and the effect is satisfactory.

关 键 词：桡骨头骨折 肘前方入路 肘关节 

分 类 号：R687.3[医药卫生—骨科学]