桡骨头颈骨折治疗方法的选择与疗效观察

Clinical observation on the different treatments targeted at different types of radial head fracture and radial neck fracture

目的探讨不同类型桡骨头颈骨折的治疗方法，并对其临床疗效进行评价。方法对2006年2月至2007年3月收治的87例桡骨头颈骨折患者的临床资料进行回顾性研究。其中桡骨头骨折54例，男性36例，女性18例；年龄18—65岁，平均33岁；按照Mason分型：Ⅰ型15例，Ⅱ型23例，Ⅲ型16例；致伤原因：摔伤40例，交通伤8例，坠落伤6例。桡骨颈骨折33例，男性21例，女性12例；年龄9—17岁，平均13岁；按O’brien分型：Ⅰ型8例，Ⅱ型14例，Ⅲ型11例；致伤原因：摔伤29例，交通伤1例，坠落伤3例。桡骨头骨折MasonI型给予肘关节功能位石膏固定，MasonⅡ型行切开复位微型钉或桥式“T”型钢板固定，MasonⅢ型中严重粉碎性骨折行桡骨头假体置换术，而骨折块较大、块数小于3块的MasonⅢ型骨折应用桥式锁定钢板固定，修复损伤的环状韧带。桡骨颈骨折O’brienI型骨折行肘关节功能位石膏固定，O’brienⅡ、Ⅲ型骨折均行撬拨复位经皮内固定。结果所有患者均获随访，随访时间4—12个月，平均7．2个月，参照Wheeler评价系统评定疗效，桡骨头骨折优26例，良20例，可6例，差2例，优良率85．2％；桡骨颈骨折优20例，良9例，可4例，差0例，优良率87．9％。结论不同类型的桡骨头颈骨折要根据其损伤特点选择不同的治疗方法，解剖复位，保留桡骨头结构，早期修复和保护环状韧带和早期功能锻炼是桡骨头颈骨折术后功能恢复良好的保证。

Objective To assess the effect of the different treatments targeted at different types of radial head fracture and radial neck fracture. Methods A retrospective study was performed in 87 patients from February 2006 to March 2007. Fifty-four patients with radial head fractures included 36 males and 18 females, aged from 18 to 65 years （the average age was 33 ） ;Forty of them resulted from crashing, 8 from traffic injury and 6 from falling injury. According to Mason classification system, there were 15 type Ⅰ , 23 type Ⅱ and 16 type Ⅲ. Thirty-three patients with radial neck fractures included 21 males and 12 females, aged from 9 to 17 years （the average age was 13） , 29 of them resulted from crashing, 1 from traffic injury and 3 from falling injury. According to O＇brien classification system, there were 8 type Ⅰ , 14 type Ⅱ and 11 type Ⅲ. Type Ⅰ of radial head fractures and radial neck fractures were immobilizated with cast, the patients with type Ⅱ of radial head fractures were treated with open reduction and micro-screw or T-trapezoid and bridge-shaped plate fixation and type Ⅲ had operations to fix with bridge-shaped locked plate and repair the broken annular ligament, or replace heads with prosthesis. All patients with type Ⅱ and type Ⅲ of radial neck fractures were treated with closed reduction by leverage and percutaneous intra-medullary nailing. Results The patients were followed up for 4-12 months （mean 7. 2 months）. The functional recovery degrees were evaluated with Wheeler＇s evaluation system. In group of radial head fractures, the results were excellent in 26 patients, good in 20, fair in 6 and poor in 2, the excellent and good rate was 85.2%. In group of radial neck fractures, the results were excellent in 20 patients, good in 9, fair in 4 and poor in no patient, and the excellent and good rate was 87. 9%. Conclusions Different types of fractures should choose different surgical methods according to their characters. The excellent functional recovery depend on anatomical reduction, retaining the head of radius, early repairing and protecting the broken annular ligament of radius, and early functional training.