桡骨小头粉碎性骨折两种手术方法的疗效分析

Comparison between Two Operations in Clinical Treatment of the Fractures of Radial Head

目的比较研究桡骨小头切除术与桡骨小头置换术治疗Mason、型桡骨小头粉碎性骨折的临床疗效。方法1997年1月至2006年5月,共收治26例Mason、型桡骨小头粉碎性骨折,14例行桡骨小头切除术,12例行桡骨小头置换术。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了比较研究。结果两组分别平均随访5.2年和2年,切除组平均肘关节痛觉及视觉模拟(VAS)评分为18.7分,置换组为23.5分(P<0.01);切除组肘关节伸直角度平均-12.4°,置换组平均-5.8°(P<0.01);切除组肘关节屈曲度、前臂旋转活动度与置换组差异无显著性差异(P>0.05),但两组的伸肘、旋前以及旋后肌力减弱差异有显著性差异(P<0.01);切除组提携角平均增大8.7°、桡骨移位2.1 mm,置换组分别为1.3°和0.3 mm,差异有显著性差异(P<0.01);切除组Broderg和Morrey肘关节功能评分平均为80.3分,置换组为91.3分(P<0.01)。结论与桡骨小头切除术相比,桡骨小头置换术治疗Mason、型桡骨小头粉碎性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良好的关节功能恢复。

Objective To compare the clinical results of radial head resection with those of radial prothesis replacement and internal fixation in treatment of Mason type- Ⅲ Ⅳ comminutad fracture of radial head. Methods 26 case of Mason type-Ⅲ Ⅳ radial head fracture were treated in our department from January 1997 to May 2006.14 cases had resection of the fractured radial head ,while the other 12 cases had radial prothesis replacement. The outcomes were assessed on the basis of pain,motion,strength,radiographic findings,and elbow functional rating score. Results The resection group had a main follow-up of 5.2 years,while the radial prothesis replacement group had 2 years. The average pain VAS （visual analog scale） score was 18. 7 for the resection group and 23. 5 for the replacement group. The elbow extension averaged -12.4°in the resection group and -5.8°in the replacement 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 replacement group （P〈0.01）. The mean Broberg and Morrey functional rating score was 80.3 for the resection group and 91.3 for the replacement group （P〈0.01）. Conclusion Compared with resection of the fractured radial head,radial prothesis replacement can result in more satisfactory elbow motion,greater muscle strength and better functional recovery in the treatment of Mason type- Ⅲ Ⅳ comminutad fracture of radial head.