SPIN螺钉治疗成人Mason-Ⅱ型和Ⅲ型桡骨小头骨折

Treatment of Mason type-II &III adult radial head fractures with SPIN screws

目的比较和评估成人Mason-Ⅱ型和Ⅲ型桡骨小头骨折采用桡骨小头切除和切开复位SPIN螺钉内固定的治疗效果。方法共有59例Mason-Ⅱ型和Ⅲ型桡骨小头骨折纳入研究。35例采用桡骨小头切除术(甲组),24例采用切开复位SPIN螺钉内固定方法(乙组)。平均年龄43岁和38岁,平均随访5.1年和1.3年。根据Broberg和Morrey评分标准,通过对患者的疼痛程度、活动范围、肌力和影像学资料评估肘关节功能。结果甲组平均伸肘丢失14.7°,屈肘132.1°,乙组分别为7.2°和134.4°。提携角甲组平均为8.5°,乙组平均为1.7°。和乙组相比,甲组伸肘、前臂旋前和旋后肌力明显下降(<0.01)。Broberg和Morrey评分甲组平均为80.6分,乙组平均为91.3分。(=0.0035)结论:Mason-Ⅱ型和Mason-Ⅲ型桡骨小头骨折采用SPIN螺钉进行内固定治疗比采用桡骨小头切除术治疗能获得更大的活动范围,更好的肌力和更好的功能。结论支持我们建议Mason-Ⅱ型和Mason-Ⅲ型桡骨小头骨折采用SPIN螺钉进行内固定治疗。

Objective To evaluate and compare the results of radial head resection with those of open reduction and internal fixation with SPIN screws in patients with Mason type-Ⅱ or Ⅲ adult radial head fractures. Methods Fifty-nine patients with a Mason type-Ⅱ or type-Ⅲ radial head fracture were enrolled in the study. Tirty-five patients underwent radial head resection as the initial treatment （Group I）, and Twenty-four patients underwent open reduction and internal fixation with SPIN screws （Group Ⅱ）. The age at the operation averaged 43 and 38 years, respectively, and the duration of followup averaged 5.1 and 1.3 years, respectively. The outcomes were assessed on the basis of pain, motion, radiographic findings, and strength measured. The overall outcome was rated with the functional rating score described by Broberg and Morrey. Results Elbow motion averaged 14.7° （extension loss） to 132.1° （flexion） in Group 1 and 7.2°to 134.4° in Group Ⅱ. The carrying angle averaged 8.5°in Group I and 1.7°in Group Ⅱ. Compared with Group Ⅱ, Group I had a loss of strength in extension, pronation, and supination （P 〈 0.01）. The Broberg and Morrey functional rating score averaged 80.6 points in Group I and 91.3 points in Group Ⅱ （P - 0.0035）. Conclusion The patients in whom the Mason type-Ⅱ ＆Ⅲ adult radial head fractures were treated with open reduction and internal fixation with SPIN screws had satisfactory joint motion, with greater strength and better function than the patients who had undergone radial head resection, These results support a recommendation for open reduction and internal fixation with SPIN screws in the treatment of this fracture.