Mason Ⅲ型粉碎性桡骨小头骨折不同手术方法疗效分析

Comparison between radial head resection and open reduction and internal fixation in clinical treatment of Mason type- Ⅲ comminuted fractures of radial head

目的比较研究桡骨小头切除与切开复位内固定治疗MasonⅢ型粉碎性桡骨小头骨折的临床效果。方法1983年1月～2005年7月共收治58例MasonⅢ型粉碎性桡骨小头骨折,28例行桡骨小头切除术,30例行切开复位内固定。通过随访对两组患者的肘、腕关节的疼痛、运动、肌力、X线表现,以及肘关节功能评分进行比较研究。结果两组分别平均随访10年和5.5年,切除组平均肘关节痛觉满意视觉模拟评分(VAS评分)18.7分,内固定组23.5分(P<0.01);切除组肘关节伸直角度平均-12.4°,内固定组平均-5.8°(P<0.01);切除组肘关节屈曲度、前臂旋转活动度与内固定组差异无显著性意义(P>0.05),但两组伸肘、旋前以及旋后肌力减弱差异有极显著性意义(P<0.01)。切除组提携角平均增大8.7°、桡骨移位2.1mm,内固定组分别为1.3°和0.3mm,差异有极显著性意义(P<0.01)。切除组Broderg和Morrey肘关节功能评分平均80.3分,内固定组91.3分(P<0.01)。结论与桡骨小头切除术相比,切开复位内固定治疗MasonⅢ型粉碎性桡骨小头骨折可获得较满意的关节活动范围、得到较大的肌力恢复以及较好的关节功能恢复。

Objective To compare the clinical results of radial head resection with those of open reduction and internal fixation in treatment of Mason type-Ⅲ comminuted fracture of radial head. Methods 58 cases of Mason type-Ⅲ radial head fracture were treated in our department from January, 1983 to July, 2005. 28 cases had resection of the fractured redial head, while the other 30 cases had open reduction and internal fixation. The outcomes were assessed on the basis of pain, motion, strength, radiographic findings, and elbow functional rating score. Results The resection group had a mean follow-up of 5.5 years （2 to 6）, while the internal fixation group had 10 years （3 to 13）. The average pain VAS （visual analog scale） score was 18.7 （11 to 25） for the resection group and 23.5 （17 to 25） for the fixation group with a P value of 0. 0023. The elbow extension averaged - 12. 4° in the resection group and - 5.8° in the fixation group （ P 〈 0. 01 ） . The elbow flexion and the forearm rotation range showed no statistical difference between the 2 groups（ P 〉 0. 05 ）, but the decrease of elbow extension and forearm rotation differed statistically between the 2 groups （ P 〈 0. 01 ）. In the resection group the carrying angle averaged 8.7° and shift of radius averaged 2. 1 mm while 1.3° and 0. 3 mm in the fixation group （ P 〈 0. 01 ）. The mean Broberg and Morrey functional rating score was 80. 3 for the resection group and 91.3 for the fixation group（ P 〈 0. 01 ） . Conclusion Compared with resection of the fractured radial head, open reduction and internal fixation can result in more satisfactory elbow motion, greater muscle strength and better functional recovery in the treatment of Mason type-Ⅲ comminuted fracture of radial head.