人工桡骨头置换治疗肘关节不稳定的桡骨头粉碎性骨折

Radial head replacement with titanic prosthesis for the treatment of comminuted fracture of the radial head associated with elbow instability

目的探讨钛制人工桡骨头置换治疗肘关节不稳定的桡骨头粉碎性骨折的疗效。方法自2000年1月至2003年8月采用钛制人工桡骨头置换治疗肘关节不稳定的桡骨头粉碎性骨折18例,男13例,女5例;年龄24～47岁,平均34.8岁。左侧8例,右侧10例。合并同侧肘关节其他骨折3例,其中桡骨近端粉碎性骨折1例,尺骨冠状突骨折2例;合并同侧上肢其他部位骨折4例,其中桡骨远端骨折3例,肱骨外科颈骨折1例。按Mason分型,Ⅲ型10例,Ⅳ型7例,Essex-Lopresti损伤1例;所有患者均为闭合性损伤,除4例为伤后3周以上的陈旧性骨折脱位外,其余均为伤后2周内的新鲜损伤。伤后至手术的时间平均为9d(4～26d)。结果术后平均随访29个月(12～44个月)。按Broberg和Morrey评估标准进行功能评定,优8例(44.4%),良8例(44.4%),可1例(5.6%),差1例(5.6%),优良率为88.9%。未见切口感染、神经损伤、金属异物反应、肘外翻增大及腕部畸形等并发症。X线片显示置换的桡骨头假体稳定,未发现桡骨短缩、上移和下尺桡关节半脱位。假体的生物相容性良好,未见炎性反应和金属异物反应。6例肘部有轻度异位骨化,但未对肘和前臂的运动造成明显影响。结论钛制人工桡骨头置换治疗肘关节不稳定的桡骨头粉碎性骨折可获得比较满意的疗效。

Objective To explore the clinical efficacy of radial head replacement with titanic prosthesis for comminuted fractures of the radial head associated with elbow instability. Methods From 2000 to 2003, a total of 18 patients, 13 men and 8 women （mean age, 34.8 years, range, 24-47 years） underwent radial head replacement with titanic prosthesis for comminuted fractures associated with elbow instability. All were the close fractures, left elbow in 8 and right elbow in 10 cases. 3 patients suffered multiple fractures in ipsilateral elbow, including proximal comminuted fracture of radius in 1, fracture of coronoid process in 2. 4 patients suffered simultaneous fracture in ipsilateral upper extremity, including distal fracture of radius in 3,fracture of surgical neck of humerus in 1. According to Mason classification, 10 fractures were of type Ⅲ, 7 of type Ⅳ, and 1 with Essex-Lopresti injury. 4 cases were old fractures and dislocations, the other 14 were of fresh injuries within 2 weeks. Operations were undertaken averagely in 9 days after injury （range, 4-26 days）. Results Patients were followed from 12 to 44 months （average, 29 months）. According to Broberg and Morrey scoring system, 8 patients （44.4%） were rated as excellent, 8 （44.4%） as good, 1 （5.6%） as fair, and 1 （5.6%） as poor. The rate of excellent and good results was 88.9%. No cases of infection, neural injury, foreign body reaction, exacerbation of cubitus valgus or deformity of wrist was found. On X-ray films, all of the titanic radial head prosthesis were stable, no shortening or proximal migration of radius, or subluxation of distal radioulnar joint was found. No sign of inflammatory reaction was noted. Mild heterotopic ossification was found in 6 elbows, but no distinct resulted limitation of locomotion. Conclusion The radial head replacement with titanic prosthesis provides an effective method for the treatment of comminuted fractures of the radial head associated with elbow instability.