MasonⅡ、Ⅲ型桡骨头骨折不同手术方法的比较

Comparison for various kinds of operative methods of Mason typeⅡ、Ⅲ fractures of radial head

[目的]比较桡骨头切除术和切开复位内固定术治疗M asonⅡ、Ⅲ型桡骨头骨折的疗效。[方法]45例M asonⅡ、Ⅲ型桡骨头骨折患者分为A、B两组,其中A组23例患者行桡骨头切除术,B组22例患者行切开复位内固定术。随访时通过对肘关节疼痛、活动范围、X线检查和肌力等方面的评估来比较两组患者的疗效,并根据B roberg和Morrey功能评分系统对总体疗效进行评估。[结果]两组患者均获随访,随访时间:A组平均8 a,B组平均3 a。在肘关节疼痛VAS评分,B roberg和Morrey功能评分、提携角和桡骨移位方面,两组比较差异有统计学意义(P<0.01)。与B组比较,A组的伸肘、前臂旋前旋后力量及活动范围和握力较小(P<0.01),但屈肘力量和肘关节屈伸范围两组无明显差异(P>0.05)。[结论]切开复位内固定术治疗M asonⅡ、Ⅲ型桡骨头骨折较桡骨头切除术更能获得满意的关节活动,且关节功能和肌力恢复较好。

[ Objective] To compare curative effects of radial head resection with internal fixation in treatment of Mason type- Ⅱ、Ⅲ fracture of radial head. [ Method] Forty-five patients with Mason type- Ⅱ、Ⅲ fracture of radial head were dividered into 2 groups（A and B）. The patients in group A（n =23） were performed with radial head resection. The patients in group B（n =22） were performed with open reduction and internal fixation. The results of the two groups were assessed for statistical analysis on the following aspects： pain, motion, strength and X-ray finding. Broberg and Morrey criterion were used to compared curative effect of elbow function between the two groups. [ Result ] The patients in the two groups were followed up for a mean time of 8 years （group A） or 3 years（ group B）. The difference of the pain VAS score, mean flexion/extension of the elbow,Broberg and Money elbow scores, carrying angle and shift of radius between the two groups were with statistical significance（ P 〈0.01 ）. In comparing with the group B, the power of gripping and the strength of forearm rotation and elbow extension for the group A decreased（ P 〈 0.01 ）, the mean pronation/supmation of the forearm for the group A decreased（ P 〈 0.01 ）. The strength of elbow flexion and the mean flexion/extension of the elbow showed no statistical difference between the two groups （ P 〉 0.05 ）. [ Conclusion ] In comparing with the radial head resection, open reduction and internal fixation can obtain more satisfactory elbow motion, greater muscle strength and better joint function m the treatment of Mason type- Ⅱ、Ⅲ fracture of radial head.