内固定与假体置换治疗MasonⅢ型桡骨头骨折的比较研究

A comparative study of internal fixation and prosthesis replacement for radial head fractures of Mason typeⅢ

目的比较切开复位内固定术与双极桡骨头假体置换术治疗MasonⅢ型桡骨头骨折的疗效。方法对17例MasonⅢ型桡骨头骨折患者采用Tornier骨水泥柄、双极桡骨头假体进行置换,其中新鲜Ma- sonⅢ型骨折15例,陈旧性MasonⅢ型骨折2例。手术均采用肘关节后外侧入路,17例均行环状韧带修复。术后48 h开始关节逐步被动功能操练。另外8例MasonⅢ型桡骨头骨折患者采用肘后外侧入路切开复位空心钉与多枚克氏针内固定作为对照。结果假体置换组14例患者得到6～27个月(平均12．5个月)随访,按照Broberg和Morrey的肘关节功能评分标准进行评分：优9例,良4例,可1例,优良率为92．8%；3例出现异位骨化,下尺桡关节未见异常改变。8例MasonⅢ型桡骨头骨折内固定患者均得到10～21个月(平均14个月)随访,肘关节功能评分：良1例,可4例,差3例,优良率为12．5%。两组间优良率比较差异有极显著性意义(O＜0．01)。结论采用双极桡骨头假体置换的方法治疗MasonⅢ型桡骨头骨折比切开复位内固定的方法更有利于恢复肘关节的稳定、伸屈活动及前臂的旋转活动。

Objective To compare ORIF （open reduction and internal fixation） and bipolar radial head prosthesis replacement in treatment of radial head fractures of Mason types Ⅲ. Methods Tornier cement stem and hipolar radial prosthesis were used to treat 15 fresh cases and two old cases of Mason type Ⅲ radial head fracture. The posterior-lateral approach was applied and annular ligament reconstruction performed tor the above 17 patients. Passive rehabilitation was started for the patients with Mason type Ⅲ radial head fracture 48 h postoperatively. As a control group, other eight cases of Mason type Ⅲ radial head fracture were managed with ORIF with eannulated screws and ＂K＂ wires through postero-lateral approach. Results The 14 patients who had received radial head replacement were followed up for 6 to 27 months, with an average of 12.5 months. According to elbow functional evaluation criteria by Broberg and Morrey, we found excellent results in nine cases, good in four and fair in one. In the ORIF group, the eight cases were followed up for 14 months on average, with good results in one case, fair in four and poor in three. Conclusion Cement stem and bipolar radial head prosthesis replacement is better than ORIF in treatment of Mason type Ⅲ fractures of the radial head, because it can better restore the stability, flexion and extension of the elbow, and the rotational motion of the forearm.