双极桡骨头假体置换的初步报道

Bipolar radial head replacement for treatment of comminuted radial head fractures:a preliminary report

[目的]寻求严重粉碎性桡骨头骨折重建桡骨头的治疗手段,推广使用双极桡骨头假体置换的新技术。[方法]临床应用5例,男2例,女3例,平均37.4岁(29～48岁),均为新鲜桡骨头骨折,MasonⅢ型4例,MasonⅣ型1例。所有患者伤后3～11 d(平均6 d)均Ⅰ期行双极桡骨头假体置换,手术采用肘关节后外侧入路。MasonⅢ型骨折病例术后48 h开始关节逐步主被动功能操练。MasonⅣ骨折的1例患者同时行肘关节内、外侧副韧带的修复,术后在支具保护下进行功能锻炼。手术后按照broberg、morrey功能评分系统进行临床观察评价。[结果]所有患者切口均Ⅰ期愈合,病例均得到随访,时间7～50个月(平均30个月),随访时broberg、morrey功能评分平均92.2分,优3例,良2例,无明显不良反应。[结论]双极桡骨头假体因其自身的特点和更符合现代关节外科假体设计的理念,是治疗严重粉碎桡骨头骨折的理想方法。

[ Objective ] To seek for a method to rebuild radial head for comminuted radial head fractures, and recommend a new technique of bipolar radial head replacement. [ Method] Five patients with fresh comminuted radial head fractures were treated by Tomier cement stem and bipolar radial prothesis. Among them, three were females and two were males, with the average age of 37.4Y（ 29 -48Y）. Four cases were to Mason type Ⅲ and one Mason type Ⅳ. All the patients underwent operation within 3 - 11 days with an average of 6 days after injury. Rehabilitation began in Mason type Ⅲ .radial head fracture patients 48 h postoperatively. Both medial and lateral ligaments were repaired in one case of Mason type Ⅳ fracture. Plastic brace were used for 3 weeks during functional rehabilitation. The postoperative elbow joint was evaluated clinically by Broberg and Morrey score. [ Result]All the patients healed by first intention were followed up for 7 to 50 months, with an average of 30 months. According to elbow functional evaluation criteria by Broberg and Morrey scores, there were excellent results in three and good in two respectively with an average of 92.2 points. [ Conclusion] Cement stem and bipolar radial head prothesis replacement is a good technique for treating comminuted radial head fractures because it meets the designing principle of modem orthopaedics.